The 3M APR DRG methodology classifies hospital inpatients according to their reason for admission, severity of illness and risk of mortality.
3M APR DRGs are used by payers, hospitals and researchers. Payers often use 3M APR DRGs as the basis for an inpatient prospective payment method and as the risk adjustor in measuring hospital quality. Hospitals often use 3M APR DRGs in combination with Solventum reimbursement calculation software to predict and verify expected reimbursement. Hospitals and researchers use 3M APR DRGs to understand utilization, measure quality and calculate efficiency measures such as risk-adjusted cost per stay.
Here are a few examples of how the 3M APR DRG patient classification methodology can bring value to health care organizations.
3M APR DRG grouping logic is the same for every payer, although different payers choose different configuration options and may follow different update schedules. Each payer that uses 3M APR DRGs makes its own decisions about prices and payment policies. For hospitals, other providers, health plans and other organizations that seek to understand, predict and verify expected payment, Solventum makes available software that emulates payer-specific grouping, pricing and payment policy. As of 2021, this payment prediction software is available for approximately 30 payers nationwide.
Solventum also makes available reimbursement calculation software for national payers that do not use 3M APR DRGs, including Medicare DRGs and TRICARE DRGs.
3M APR DRGs are integrated with other Solventum patient classification methodologies.
Solventum has aligned the service line definitions between 3M APR DRGs for inpatient care and the 3M™ Enhanced Ambulatory Patient Groups (EAPGs) for outpatient care. This alignment allows analysis of charges, cost, payment and utilization by service line across both inpatient and outpatient settings.
3M APR DRGs are used to risk adjust the 3M™ Potentially Preventable Complications (PPCs) and 3M™ Potentially Preventable Readmission (PPR) methodologies. 3M PPCs measure the incidence of a wide range of inpatient complications while 3M PPRs are a well-accepted measure of the quality of both inpatient care and post-discharge follow-up in the community.
3M APR DRGs are used to define 3M™ Potentially Preventable Admissions, which are a measure of population health.
3M APR DRGs are used to define certain 3M PFEs. For example, 3M APR DRG 301-1 Hip Joint Replacement triggers Patient-focused Episode 3011 Hip Replacement Procedure.
3M APR DRGs are available in the following Solventum products:
Licensees of the 3M APR DRG methodology have access to the following documents on the Solventum customer support website:
Solventum experts are available to advise provider organizations, health plans, government agencies and other interested parties on how to obtain maximum value from using the 3M APR DRGs. For example, Solventum consultants can help hospitals implement clinical documentation integrity (CDI) programs and use 3M APR DRGs to measure and improve their own cost efficiency and quality of care. Solventum consultants can also help payers design payment methods based on 3M APR DRGs and demonstrate how to use 3M APR DRGs to understand patterns of utilization, charges, cost and payment.
The unit of analysis is an inpatient stay at an acute care hospital. All the data required to assign a 3M APR DRG can be obtained from a standard inpatient hospital discharge record, such as the UB-04 form or the X12N 837I electronic transaction. Data fields that are particularly important for 3M APR DRG assignment include all diagnosis codes, present on admission indicators, ICD-10-PCS procedure codes and procedure code date.
3M APR DRGs were first released in 1991. The 3M APR DRG logic uses claims data to assign patients to one of 332 base 3M APR DRGs that are determined either by the principal diagnosis or, for surgical patients, the most important surgical procedure. Each base 3M APR DRG is then divided into four severity of illness (SOI) levels, determined primarily by secondary diagnoses that reflect both comorbid conditions and the severity of the underlying illness, creating the final set of 1,330 3M APR DRGs. The 3M APR DRG logic computes both an admission severity of illness and a discharge severity. The present-on-admission (POA) indicator for each secondary diagnosis is a required data field for computing the severity of illness at the time of admission.
For example, 3M APR DRG 139-1 is Other Pneumonia, severity of illness 1 (minor) while 3M APR DRG 139-4 is Other Pneumonia, severity of illness 4 (extreme). Each base DRG also has four risk-of-mortality levels. Although severity of illness is often correlated with risk of mortality, the two concepts are different and it is possible for a patient to have a high severity of illness but a low risk of mortality. Acute cholecystitis is an example.
The clinical logic is maintained by a team of Solventum clinicians, data analysts, programmers and economists. The logic is proprietary to Solventum but is available for licensees to view in an online definitions manual.
Each year Solventum calculates and releases a set of statistics for each 3M APR DRG based on our analysis of large national data sets. These statistics include a relative weight for each 3M APR DRG. The relative weight reflects the average hospital resource use for a patient in that 3M APR DRG relative to the average hospital resource use of all inpatients. Please note that payers and other users of the 3M APR DRG methodology are responsible for ensuring that they use relative weights that are appropriate for their particular populations. The 3M APR DRG statistics also include data for each 3M APR DRG on relative frequency, average length of stay, average charges and incidence of mortality.
3M APR DRGs can be rolled up into broader categories. The 332 base DRGs roll up into 25 major diagnostic categories (MDCs) plus a pre-MDC category. An example is MDC 04, Diseases and Disorders of the Respiratory System. As well, each 3M APR DRG is assigned to a service line that is consistent with the outpatient service lines that are defined by the 3M™ Enhanced Ambulatory Patient Groups (EAPGs). An example is service line 01.7, General Medicine – Pulmonary.
Solventum releases a new version of the 3M APR DRGs every October 1, to reflect updates in the ICD-10 diagnosis and procedure code sets and to include enhancements to the clinical classification logic.