Solventum™ International Refined Diagnosis Related Groups (IR DRGs) Classification System

The Solventum IR DRG patient classification methodology differentiates between inpatient and ambulatory encounters, while consistently grouping cases with similar resource consumption. Each Solventum IR DRG code describes patients who are similar both clinically and in their resource consumption.

Solventum IR DRGs are used by healthcare regulators, payers, hospitals and researchers worldwide as part of funding systems and for budgeting, outcomes analysis, benchmarking, performance measures and utilization assessment. The classification system can compare resource usage across facilities and regions and support local and national health system management.

Solventum IR DRGs are designed for all patient populations, including sick and healthy newborns, pediatrics and obstetrics and for all patient settings except long-term care. The Solventum IR DRG classification system can group all types of inpatients and ambulatory patients, including:

Here are a few examples of how the Solventum IR DRG patient classification methodology can bring value to health care organizations:

• Appropriate payment incentives. Implementing a Solventum IR DRG payment method rewards efficiency, because payment does not depend on hospital-specific costs or charges. At the same time, a Solventum IR DRG payment method creates incentives to increase access to care, because higher severity Solventum IR DRGs receive higher payment rates.
  
  
• Predict and verify expected payment. Solventum makes available reimbursement calculation software that enables providers to predict and verify expected payment using a specific payer’s Solventum IR DRG pricing policy.
  
  
• Public reporting. Because Solventum IR DRGs define “the product of a hospital,” they are useful in public reporting and other comparisons across hospitals and regions.
  
  
• Quality comparisons. Solventum IR DRGs have been used in multiple analyses as the risk adjustor to make fair comparisons across hospitals on quality measures such as mortality, potentially preventable complications and potentially preventable readmissions.
  
  
• Clinical insight. Hospitals, state agencies, payers and researchers use Solventum IR DRGs to yield insights about clinical care. For example, analysis in multiple states has quantified the sharp inverse relationship between birth weight and the hospital’s cost of neonatal care.
  
  
• Financial analysis. Hospitals, state agencies, payers and researchers use Solventum IR DRGs to risk adjust measures such as charges, hospital cost and average length of stay to create fair comparisons of utilization and efficiency across service lines, hospitals and other populations.

Solventum IR DRG classification logic is the same for every user, although different organizations may use different versions. (The most recent version is recommended.) Each licensee makes its own decisions about appropriate uses. At this time, Solventum does not offer software that replicates the Solventum IR DRG analysis used in specific countries.

Solventum IR DRGs are derived from and integrated with other Solventum patient classification methodologies. For example:

• The Solventum IR DRG logic for inpatient care is based on the Solventum™ All Patient Refined Diagnosis Related Groups (APR DRGs) Classification System that is widely used in the U.S. for payment and risk adjustment. Countries such as Spain and Belgium also use Solventum APR DRGs for reporting and payment adjustment.
• The Solventum IR DRG logic for ambulatory care (e.g., emergency departments, other hospital outpatient departments, physician clinics, etc.) is based on the Ambulatory Payment Classifications (APCs), the widely used outpatient classification system developed in the U.S. by the Centers for Medicare & Medicaid Services (CMS).
• Solventum IR DRGs also provide risk adjustment in measuring inpatient mortality using the risk-of-mortality (ROM) subclasses to evaluate inpatient quality outcomes. For inpatient complications, the Solventum™ Potentially Preventable Complications (PPCs) Classification System is applied, and for readmissions, the Solventum™ Potentially Preventable Readmissions (PPRs) Classification System is used.

Solventum IR DRGs are available in the following Solventum products:

• Solventum™ 360 Encompass™ System
• Solventum™ Coding and Reimbursement System
• Solventum™ Advanced CDI Transformation Program
• Solventum™ Clinical Documentation Improvement Solution
• Solventum™ Core Grouping Software (CGS)

Licensees of the Solventum IR DRG methodology have access to the following documents on the Solventum customer support website:

• Solventum IR DRG Summary of Changes
• Solventum IR DRG Definitions Manual
• Solventum IR DRG Weights and Trims with Code Descriptions

Solventum experts are available to advise government agencies, hospitals, third parties and other interested entities on how to obtain maximum value from the use of the Solventum IR DRGs. For example, Solventum consultants can help you assess options for improving payment methods, implementing patient classification methods, adapting the Solventum IR DRGs to country-specific code sets, and measuring and improving health care outcomes.

The Solventum IR DRG classification system is a robust choice for the international market because it provides consistent classification for patients regardless of the coding systems used, making international comparisons possible. Solventum IR DRGs use procedures rather than principal diagnosis as a starting point to better align with ambulatory components and reduce redundancy.

All the data required to assign a Solventum IR DRG code can be obtained from standard patient records. Crucial data fields for Solventum IR DRG assignment include all procedure and diagnosis codes, present-on-admission indicators (POAs), procedure code dates, length of stay and basic patient demographics.

The first version of the Solventum International Refined-Diagnosis Related Groups (IR-DRGs) was developed to provide a patient classification system that would result in the same Solventum IR-DRG assignment regardless of the coding system used. The system encompasses a wide variety of coding systems, providing an accurate basis for comparing inpatient utilisation across countries.

The development objective of the second version of the Solventum IR-DRGs is to create a single Solventum IR-DRG classification system that can group all types of patients. Many international patients previously evaluated and treated in an inpatient setting are now being evaluated and treated in an ambulatory setting, and in many countries, there is not a clear distinction between inpatient and ambulatory care. This trend created the need for a single Solventum IR-DRG system that spans the complete continuum of care settings.

Since Solventum IR-DRG version 2.0, the Solventum IR-DRGs have encompassed all patient settings except long-term care. Solventum IR-DRGs can group all types of inpatients and ambulatory patients.

The system’s inpatient component is derived from the Solventum™ All Patient Refined Diagnosis Related Groups (APR DRGs) and includes three levels of adjustment for severity of illness to better capture the complexity of modern health care using fewer categories than other DRG systems. The core ambulatory component is derived from Solventum Ambulatory Patient Groups (APGs), predecessor of the Solventum™ Enhanced Ambulatory Patient Groups (EAPGs) Classification System, and the Ambulatory Payment Classification (APCs), developed for Centres of Medicare and Medicaid Services.

Solventum IR-DRGs use different procedure types and categories to discriminate between procedural groups and allocate specific Major Diagnostic Categories (MDCs), when applicable. Unlike other less sophisticated grouping methodologies, Solventum IR-DRGs natively support ICD-10 WHO and ICD-10-CM (USA) diagnoses, ICD-10 PCS (USA) procedures, CPT® interventions classification, as well as variants and predecessor versions such as ICD-9-CM.

The latest version of Solventum IR-DRGs uses the full capacity of the ICD-10-CM diagnosis and intervention codes. This helps to link with quality and outcome measures by using indicators from the Solventum™ Potentially Preventable Readmissions (PPRs) Classification System. Indicators from the Solventum™ Potentially Preventable Complications (PPCs) Classification System are also used to identify present-on-admission flags and generate admission and discharge data for the Solventum IR-DRGs.

Solventum IR-DRGs are continuously maintained to reflect current knowledge and classifications used worldwide, accommodating country-specific modifications and procedure coding systems. The Solventum IR-DRG classification system contains the powerful severity-of-illness (SOI) subclasses for payment and production efficiency measurement and the risk-of-mortality (ROM) subclasses to evaluate quality.

Solventum calculates and releases a set of statistics for each version of Solventum IR-DRG based on our analysis of large, national data sets. These statistics include a relative weight for each Solventum IR-DRG. The relative weight reflects the average resource use for a patient in that Solventum IR-DRG relative to the average Solventum IR-DRG. Please note that payers and other users of the Solventum IR-DRG methodology are responsible for using relative weights appropriate for their populations.

The Solventum IR-DRG logic is proprietary to Solventum and maintained by a team of Solventum clinicians, data analysts, nosologists, programmers and economists. The methodology is updated annually to reflect changes in the standard diagnosis and procedure code sets as well as Solventum enhancements to the clinical logic.