eHealth Education (eHE) is an educational, research and consulting organisation which has been collaborating with international government agencies to develop solutions for, and build understanding of, service-based costing (such as “bundling” or DRGs).
Through this work we have identified the need for health records to be designed to make capture of clinical data easier and more accurate. eHealth Education (eHE) has also found broad gaps in knowledge of how service-based costing systems work, and how such systems offer significant opportunities for healthcare organisations to improve their processes.
What we’ve found
Work with clinicians, administrators, payors, and government agencies has demonstrated:
There can be confusion in the health industry about costing and payment systems. Where health systems do not have an accounting system that can report upon actual costs of specific types of services.
A lack of the key skills needed for successful implementation of service-based payment systems and the need for identification of the data to support these systems. Development of skills in grouping of similar services and clinical activities and development of classifications and algorithms.
Problems with classification design (eg. ICD-10 and ACHI) which require duplication of data capture. For example: PAS systems collect data on whether an episode is an Expected day-stay, but the ICD classification also requires different codes if the patient is a day stay case. Duplicated data capture would be unnecessary if the day stay expected value was included in the DRG grouping algorithm.
Build capability and understanding
As healthcare moves from the billing excesses of fee-for-service to a more inclusive single invoice, and as service-based funding concepts are evolving as the key to funding across all of healthcare, there is a need for staff to have skills in data, and classifications to support implementation and design of these systems.
eHealth Education have developed a short course (FIN8_004 RGs) Introducing DRGs and service-based billing. This course covers:
how billing/funding systems work and the options available to improve efficiency and ensure control of expenses and income.
the use of tooling to establish a DRG from the data which defines the service (such as disease and procedure codes for inpatients, and clinic specialty, and follow-up visit types for outpatients),
evaluation of the source data as evidence in electronic health record systems.
the principles of service-based funding (whether it be DRGs, SRGs or other forms of service-based services)
how the grouping systems work and are designed
best practice for implementation
requirement for an Electronic Health Record (EHR) to support care and payment without bias of payment claims beyond the evidence available in the record
Summary
eHealth Education is not just a provider of education; we are pioneers shaping the future of healthcare. With our unwavering commitment to excellence and innovation, we empower individuals to navigate the complexities of the digital age - in this case, where new data and systems are used for billing or funding. Join us on the journey towards a healthier, more connected world.
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