Solventum™ All Patient Refined Diagnosis Related Groups (APR DRGs) Classification System

The Solventum APR DRG methodology classifies hospital inpatients according to their reason for admission, SOI and ROM.

Solventum APR DRGs are used by payers, hospitals and researchers. 

• Payers often use Solventum APR DRGs as the basis for an inpatient prospective payment method and as the risk adjustor in measuring hospital quality.
• Hospitals often use Solventum APR DRGs in combination with Solventum reimbursement calculation software to predict and verify expected reimbursement. 
• Hospitals and researchers use Solventum 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 Solventum APR DRG Classification System can bring value to healthcare organizations.

• Appropriate payment incentives. Implementing a Solventum APR DRG payment method rewards efficiency because payment does not depend on hospital-specific costs or charges. At the same time, a Solventum APR DRG payment method creates incentives to increase access to care because higher-severity Solventum APR 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 APR DRG pricing policy.
• Public reporting. Because Solventum APR DRGs define “the product of a hospital,” they are useful in public reporting and other comparisons across hospitals and states. 
• Quality comparisons. Solventum APR 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 APR 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 APR DRGs to risk adjust measures such as charges, hospital cost and average length of stay (LOS) to create fair comparisons of utilization and efficiency across service lines, hospitals and other populations.
• Defining episodes. The event of an inpatient stay is used in the Solventum™ Potentially Preventable Events (PPEs) Classification System to define an episode of care that includes the inpatient stay, the associated hospital and professional services, and related post-discharge services (such as rehabilitation).

Solventum 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 Solventum 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. 

Solventum also makes available reimbursement calculation software for national payers that do not use Solventum APR DRGs, including Medicare DRGs and TRICARE DRGs.

The clinical logic of Solventum APR DRGs is the basis for other specialized Solventum methodologies that help address the “preventables” in healthcare. Combining these solutions with Solventum APR DRGs allows organizations to dig into patient data, take action to prevent adverse events and improve quality outcomes. 

• The Solventum™ Potentially Preventable Readmissions (PPRs) Classification System determines whether a readmission is clinically related to a prior admission based on the patient’s diagnosis and procedure codes associated with the prior admission and the reason for readmission.
• The Solventum™ Potentially Preventable Complications (PPCs) Classification System identifies conditions not present on admission and determines whether the conditions were potentially preventable given patient characteristics, reason for admission, clinical procedures and interrelationships between underlying medical conditions. 

These clinical insights into complications enable healthcare providers to initiate root cause analysis and focus resources on areas with the greatest opportunity to advance patient safety. Along with identifying PPRs and PPCs, these tools can also calculate expected performance, evaluate the impact on costs and assess opportunities to improve hospital LOS, capacity and throughput.

Solventum APR DRGs are available in the following Solventum products:

• Solventum™ 360 Encompass™ System
• Solventum™ 360 Encompass™ Clinical Documentation Integrity System
• Solventum™ Coding and Reimbursement System (CRS)
• Solventum™ Core Grouping Software (CGS)
• Solventum™ Grouper Plus Content Services (GPCS)
• Solventum™ Data-to-Action (DTA) Solution
• Solventum™ Informed Analytics (IA) Platform

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

• Solventum™ APR DRG Methodology Overview
• Solventum™ APR DRG Summary of Changes
• Solventum™ APR DRG Definitions Manual
• Solventum™ APR DRG Software Installation and User’s Guide
• Solventum™ APR DRG Weights and Trims with Code Descriptions

Solventum experts are available to advise provider organizations, health plans, government agencies and other interested parties on how to obtain maximum value from using Solventum APR DRGs. Solventum consultants can also help payers design payment methods based on Solventum APR DRGs and demonstrate how to use Solventum 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 Solventum 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 Solventum APR DRG assignment include all diagnosis codes, present on admission (POA) indicators, ICD codes and procedure code date.

Solventum APR DRGs were first released in 1991. The Solventum APR DRG logic uses claims data to assign patients to a base Solventum APR DRG that is determined either by the principal diagnosis or, for surgical patients, the most important surgical procedure. Each base Solventum APR DRG is then divided into four SOI levels, determined primarily by secondary diagnoses that reflect CCs and the severity of the underlying illness. 

The Solventum APR DRG logic computes both an admission SOI and a discharge severity. The POA indicator for each secondary diagnosis is a required data field for computing the SOI at the time of admission.

For example, Solventum APR DRG 139-1 is Other Pneumonia, SOI 1 (minor) while Solventum APR DRG 139-4 is Other Pneumonia, SOI 4 (extreme). Each base DRG also has four ROM levels. Although SOI is often correlated with ROM, the two concepts are different, and it is possible for a patient to have a high SOI but a low ROM. 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 a set of statistics for each Solventum APR DRG based on our analysis of large national data sets and releases this information through updates to the Solventum APR DRG Definitions Manual on our support site. These statistics include a relative weight for each Solventum APR DRG. The relative weight reflects the average hospital resource use for a patient in that Solventum APR DRG relative to the average hospital resource use of all inpatients. Please note that payers and other users of the Solventum APR DRG methodology are responsible for ensuring that they use relative weights that are appropriate for their particular populations. The Solventum APR DRG statistics also include data for each Solventum APR DRG on relative frequency, average LOS, average charges and incidence of mortality.

Solventum APR DRGs can be rolled up into broader categories. The base DRGs roll up into major diagnostic categories (MDCs) plus a pre-MDC category. An example is MDC 04, Diseases and Disorders of the Respiratory System. In addition, each Solventum APR DRG is assigned to a service line consistent with the outpatient service lines defined by the Solventum EAPG Classification System. An example is service line 01.7, General Medicine – Pulmonary.

Solventum releases a new version of Solventum APR DRGs annually to reflect updates in ICD diagnosis and procedure code sets and include enhancements to the clinical classification logic.