Formula for Adjusted Relative Weight of Thai Diagnosis Related Group Version 5

Abstract

related group (DRG). Adjust for RW for short and long length of stay (LOS) will lead to equity for both providers and payers. The objective of this study was to synthesize formula for adjusted RW of Thai-DRG version 5 from charge of care per day. Patients were divided into 3 groups: low outlier, inlier, and high outlier for medical DRG or surgical DRG. For low outlier group, medical DRG had cumulative percentage of charge of care per day from day 1 to day 10 as follow: 86.0, 95.2, 97.4, 98.2, 98.7, 99.3, 99.6, 99.8, 99.9 and 100. Surgical DRG had cumulative percentage of charge of care per day from day 1 to day 14 as follow: 73.3, 86.9, 92.4, 94.7, 96.4, 97.6, 98.4, 98.9, 99.6, 99.8, 99.9, and 100.0 for day 12 onward. For high outlier group according to outlier trim point (OT) which divided into 3 groups: LOS greater than OT and lower than 2OT (OT < LOS ≤ 2OT), LOS greater than 2OT and lower than 3OT (2OT < LOS ≤ 3OT), and LOS greater than 3OT (LOS > 3OT). The results found that medical DRG should adjust 3 groups by considering actual LOS (ACTLOS), average LOS (WTLOS) and outlier trim point.

Formula for adjusted RW according to length of stay should review most common DRGs found in low and high ourliers, complexity and severity of disease, type of hospital, cost information including developing daily cost database from the hospital electronic data systems.