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

The Solventum IR DRG patient classification methodology discriminates 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 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.

The 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:

• Hospital inpatients
• Clinic
• Hospital same-day
• Office visit
• Hospital clinic
• Rehabilitation
• Emergency department
• Chemotherapy and radiation therapy

The Solventum IR DRGs are currently used in various health care systems around the world, including Hong-Kong, Chile, the United Arab Emirates, the Czech Republic and Spain.

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.

The Solventum IR DRG methodology is 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 methodology that is widely used in the U.S. for payment and risk adjustment. Countries such as Spain and Belgium also use the 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).
• The 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 methodology is applied, and for readmissions, the Solventum™ Potentially Preventable Readmissions (PPRs) Classification System methodology is used.

The Solventum IR DRGs are available in the following Solventum products:

• Solventum™ Core Grouping Software (CGS)
• Solventum™ Coding and Reimbursement System (CRS) (for ICD-10-CM/PCS and CPT® code sets)

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 utilization 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) Classification System Classification System 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 Centers 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 Grouping Software. Indicators from the Solventum™ Potentially Preventable Complications (PPCs) Classification System Grouping Software 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.

Further information on the Solventum IR DRG logic is available in the Solventum IR DRG white paper. 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.