Subject: Re: DRG WG
From: "sofiko belkania" <[email-masked]>
To: Kristiina Kahur; Nino Berdzuli
Cc: Zaza Sopromadze; 'Maia Khomeriki'; [email-masked]; 'marina darakhvelidze'; Ketevan Goginashvili; [email-masked]; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; [email-masked]; [email-masked]
Date: Mon, 23 Oct 2017 15:17:38 +0400

Dear Kristiina,

It's fine to have Skype Call on 26th of October at 4pm (Tbilisi Time).
 
Best regards,
______________________
Sopo Belkania
Head of HR Management and International Relations Department 
Ministry of Labour, Health and Social Affairs of Georgia
144 A.Tsereteli Avenue, 0159, Tbilisi, Georgia 
Mobile number: +995 599 22 32 32

-----Original Message-----
From: Kristiina Kahur <[email-masked]>
To: Sopo Belkania <[email-masked]>, 'Nino Berdzuli' 
<[email-masked]>
Cc: 'Zaza Sopromadze' <[email-masked]>, 'Maia Khomeriki' 
<[email-masked]>, "[email-masked]" 
<[email-masked]>, 'marina darakhvelidze' 
<[email-masked]>, 'Ketevan Goginashvili' 
<[email-masked]>, "[email-masked]" 
<[email-masked]>, 'Sarah Thomson' <[email-masked]>, 'Marijan 
Ivanusa' <[email-masked]>, "'HABICHT, Triin'" <[email-masked]>, 
"[email-masked]" <[email-masked]>, 
"[email-masked]" <[email-masked]>
Date: Sun, 22 Oct 2017 17:06:28 +0000
Subject: Re: DRG WG

> Dear Sopo,
> 
> 
> I get back to the time of our next Skype call once again.
> 
> Would it be possible to start the call at 4pm (Tbilisi time) instead 
of
> 3pm on Thursday 26th of October?
> 
> 
> Looking forward to getting your confirmation.
> 
> 
> Thanks,
> 
> Kristiina
> 
> 
> ________________________________
> From: Kristiina Kahur <[email-masked]>
> Sent: Friday, October 20, 2017 7:04 PM
> To: Sopo Belkania; 'Nino Berdzuli'
> Cc: 'Zaza Sopromadze'; 'Maia Khomeriki'; [email-masked]; 
'marina
> darakhvelidze'; 'Ketevan Goginashvili'; [email-masked]; 
'Sarah
> Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; 
[email-masked];
> [email-masked]
> Subject: Re: DRG WG
> 
> 
> Dear Sopo,
> 
> 
> Thank you for your feedback. Next Thursday, 26th Oct at 3pm (2pm
> Estonian/Finnish time), suits well.
> 
> 
> Thanks and have a nice weekend,
> 
> Kristiina
> 
> 
> ________________________________
> From: Sopo Belkania <[email-masked]>
> Sent: Friday, October 20, 2017 5:42 PM
> To: 'Kristiina Kahur'; 'Nino Berdzuli'
> Cc: 'Zaza Sopromadze'; 'Maia Khomeriki'; [email-masked]; 
'marina
> darakhvelidze'; 'Ketevan Goginashvili'; [email-masked]; 
'Sarah
> Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; 
[email-masked];
> [email-masked]
> Subject: RE: DRG WG
> 
> 
> Dear Kristina,
> 
> 
> 
> We have meeting today and discussed all the issues regarding 
grouping
> results and agreed to have skype call on Thursday, 26th of October 
at
> 15:00.  Is it suitable for you?
> 
> 
> 
> Looking forward for your confirmation.
> 
> 
> 
> Best regards,
> 
> 
> 
> Sopo Belkania
> 
> Head of HR Management and International Relations Department
> 
> Ministry of Labor, Health and Social Affairs of Georgia
> 
> 144 A.Tsereteli Avenue, 0159, Tbilisi, Georgia
> 
> Mobile number: +995 599 22 32 32
> 
> 
> 
> From: Kristiina Kahur [mailto:[email-masked]]
> Sent: Friday, October 20, 2017 6:01 AM
> To: Nino Berdzuli
> Cc: Zaza Sopromadze; Maia Khomeriki; [email-masked]; marina
> darakhvelidze; Ketevan Goginashvili; [email-masked]; Sarah
> Thomson; Marijan Ivanusa; HABICHT, Triin; [email-masked];
> [email-masked]; [email-masked]
> Subject: Re: DRG WG
> 
> 
> 
> Dear Nino,
> 
> 
> 
> Hope you made it home safe and sound.
> 
> I also hope you have had time to discuss the grouping results and 
agree
> on Skype call timing.
> 
> Please let me know whether next Monday 23rd of Oct before 15:30 
would
> work with you.
> 
> 
> 
> Thank you,
> 
> Kristiina
> 
> 
> 
> ________________________________
> 
> From: Nino Berdzuli 
<[email-masked]<mailto:[email-masked]>>
> Sent: Saturday, October 14, 2017 5:39 AM
> To: Kristiina Kahur
> Cc: Zaza Sopromadze; Maia Khomeriki;
> [email-masked]<mailto:[email-masked]>; marina
> darakhvelidze; Ketevan Goginashvili;
> [email-masked]<mailto:[email-masked]>; Sarah Thomson;
> Marijan Ivanusa; HABICHT, Triin;
> [email-masked]<mailto:[email-masked]>;
> [email-masked]<mailto:[email-masked]>;
> [email-masked]<mailto:[email-masked]>
> Subject: Re: DRG WG
> 
> 
> 
> Thanks, Kristina. I am currently in US, but in the office next week. 
We
> will discuss internally the progress with grouping results review as
> well as Skype call timing and get back to you mid-next week.
> 
> 
> 
> Best,
> 
> 
> 
> Nino
> 
> Sent from my iPhone
> 
> On Oct 13, 2017, at 9:44 PM, Kristiina Kahur
> <[email-masked]<mailto:[email-masked]>> wrote:
> 
> Dear all,
> 
> 
> 
> As we agreed in our last Skype meeting (2nd of Oct) we were planning 
to
> have another one before the November mission (scheduled on the 
second
> week of November) in order to let you reflect your
> comments/questions/feelings about the grouping results, the overview 
of
> suspicious cases in DRGs 468, 468O, 477 and 477O (in case you have 
had
> time to have a closer look at those) and other issues related to 
this.
> 
> In addition, we would be glad to learn what are your expectations 
for
> the next mission in order to draft the agenda according to the this.
> You may want to include other topic to our Skype meeting agenda if 
you
> feel like.
> 
> As for timing, I would suggest to have the Skype meeting on Monday,
> 23rd of Oct any time before 15:30 (Tbilisi time), so that  the call  
is
> finished by 15:30. I suggest we reserve at least one hour for the
> meeting.
> 
> Please discuss the timing and the content of the Skype meeting 
between
> yourself and let me know which time on 23rd of Oct before 15.30 
would
> suit you the best.
> 
> 
> 
> Thanks,
> 
> Kristiina
> 
> 
> 
> 
> 
> ________________________________
> 
> From: Kristiina Kahur 
<[email-masked]<mailto:[email-masked]>>
> Sent: Monday, October 2, 2017 9:39 PM
> To: Nino Berdzuli
> Cc: Zaza Sopromadze; Maia Khomeriki;
> [email-masked]<mailto:[email-masked]>; marina
> darakhvelidze; Ketevan Goginashvili;
> [email-masked]<mailto:[email-masked]>; Sarah Thomson;
> Marijan Ivanusa; HABICHT, Triin;
> [email-masked]<mailto:[email-masked]>
> Subject: Re: DRG WG
> 
> 
> 
> Dear all,
> 
> 
> 
> This is to inform you that we had another Skype meeting today.
> 
> The aim of the meeting was to present the preliminary results of the
> grouping.
> 
> Main findings were presented and discussed (and also attached to the
> email).
> 
> The whole database with information about DRG grouping results was
> shared after the meeting (Triin to Maia).
> 
> 
> 
> As for next steps, the data with grouping results should be analyzed 
by
> SSA staff (by involving other specialists if needed). The main focus
> should be on error DRGs and the content of the cases. Error DRGs 
have
> grouped to DRG470. My suggestion is to use the results of Finnish
> grouping for that because there are introduced DRG470 subgroups 
(470A,
> 470B, etc) which provide more precise information about the source 
of
> error.
> 
> It has to be taken into account, that many ICD10 codes in Finnish
> version (especially in chapter C and I) have 5 characters, while in
> Georgian version most codes have 4 characters, and thus, the 
grouping
> result with Finnish grouper is DRG470 subgroups. This necessarily 
does
> not mean that there are coding issues. Instead, the reason is 
different
> ICD10 versions in both countries.
> 
> 
> 
> In addition, you may want to conduct some additional controls in the
> hospitals based on the grouping results. It concerns the DRGs 468,
> 468O, 477 and 477O where ca 140 cases were grouped (see separate 
sheet
> in attached document). Those cases may have coding problems. But 
they
> also can be rear cases where the combination of main diagnosis and
> procedure is clinically meaningful. The best source to check it is
> medical record.
> 
> 
> 
> I will continue to work on data and submit the analytical report 
about
> the grouping results and assessment of SSA invoicing data quality 
and
> further use of them by the end of October/beginning of November.
> 
> 
> 
> If you have any urgent questions, we can deal with them asap. 
Otherwise
> you can gather your comments/questions/feelings about the grouping
> results and we will discuss them as agreed during another Skype call
> before November mission, preferable on week 47.
> 
> 
> 
> Thank you,
> 
> Kristiina
> 
> 
> 
> 
> 
> 
> 
> ________________________________
> 
> From: Kristiina Kahur 
<[email-masked]<mailto:[email-masked]>>
> Sent: Tuesday, September 19, 2017 5:08 PM
> To: Nino Berdzuli
> Cc: Zaza Sopromadze; Maia Khomeriki;
> [email-masked]<mailto:[email-masked]>; marina
> darakhvelidze; Ketevan Goginashvili;
> [email-masked]<mailto:[email-masked]>; Sarah Thomson;
> Marijan Ivanusa; HABICHT, Triin
> Subject: Re: DRG WG
> 
> 
> 
> Dear all,
> 
> 
> 
> We just had the Skype call today with Nino, Maia and colleagues and
> discussed the first results of the data we were provided last week.
> 
> 
> 
> I would like thank you (and Triin joins me) for the work you have 
done
> to derive the data from your database and prepare them for first 
check.
> 
> 
> 
> The general picture looks good. Data includes 108808 unique rows.
> 
> Nevertheless, there are some things which need to be fixed before we
> can proceed with the grouping exercise.
> 
> In current stage we focus only for data needed for groping, and only
> after that we start to deal with different tariffs and cost related
> data.
> 
> 
> 
> Here are the main findings followed by actions to be taken. The
> findings follow the order of data-fields needed for grouping:
> 
>   1.  Case ID (column A).
> 
>      *   CaseDistplayNumber is used. It’s a unique number and can be
> used later for linking additional data if needed.
> No action needed
> 
>   1.  Main diagnosis (column AA)
> 
>      *   in 248 cases the main diagnosis is missing
> Action: to find the main diagnosis for those cases.
>      *   in 28 cases instead of diagnosis code “hemotransfusion” is
> used.
> Action: to find correct main diagnosis code for those cases and use
> NCSP code for hemotransfusion (if there exist one in GEO version)
> 
>   1.  Secondary diagnosis (columns AB-AJ)
> 
>      *   in some cases instead of diagnosis code “hemotransfusion”
> and “haemodialysis” is used.
> Action: to find correct secondary diagnosis code for those cases (if
> coded) and use NCSP codes for those procedures (if there exist one 
in
> GEO version)
> 
>   1.  Procedure codes
> 
>      *   There are 16 columns for procedure codes
> 
>         *   NCSP_ძირითადი_2-
> NCSP_ძირითადი_8 (#7)
>         *   NCSP_თანმხლები_1-
> NCSP_თანმხლები_9 (#9)
> Action: The names of the columns need to be clarified. In addition, 
it
> should be checked whether or not some columns are duplicating each
> other. If so, the duplicates need to be removed.
> 
>   1.  Gender (column C)
> 
>      *   Information is there but it needs formatting
> Action: If male -> use 1, if female -> use 2, if unknown –> use 3
> 
>   1.  Age (column D)
> 
>      *   AgeInDays, the age ranges from 0 to 35272 days (0-99 years)
> and should be ok
> No action needed
> 
>   1.  Discharge
> 
>      *   For this the HospitalizationOutcome (column N) can be used.
> This information should be mapped to four different characters 
needed
> for grouping:
> 
>         *   1=any other including normal discharge to home or 
unknown
>         *   2=transferred to another hospital
>         *   3=left against medical advice
>         *   4=dead
> Action: map every HospitalizationOutcome characteristic (9 different 
in
> the table) to one of the above (1-4). Add respective column 
"Discharge"
> in the table. Keep column "HospitalizationOutcome".
> 
>   1.  Length of stay (LOS)
> 
>      *   Information is correct (minus one case).
> Action: Check the case 3310497435, were LOS is -5540.
> 
>   1.  Birthweight (column S)
> 
>      *   1170 cases with birthweight information in the data.
>      *   Birthweight ranges from 300g to 7000g? Is 300 and 7000g
> correct?
>      *   In 25 cases the birthweight information seems not to be
> relevant because the age of those cases ranges from 18 to 39 years
> Action: Check the age of those patients. If incorrect, correct the 
age.
> If correct, there is no need for birthweight information.
> 
> There is one more comment regarding the OrganizationType (column Y).
> There are 62 cases where the organization type is Family Medicine
> Center. Most of the cases (#49) are related to cataract issues, some 
of
> them have procedure codes reflecting the cataract surgery. Are those
> cases relevant to Family Medicine Centre? Can there be the coding
> issues or do the ophthalmologist work in Family Medicine Centres and
> provide respective services?
> 
> 
> 
> We agreed that the corrected data will be provided by Friday 22nd 
Sept,
> if possible. If not, then by Monday 25th Sept, as latest.
> 
> 
> 
> The next steps (given that the data are ok):
> 
>   *   Final preparation for grouping (week 39).
> 
>      *   general check
>      *   replacing the NCSP+ code with Estonian and Finnish NCSP 
codes
>      *   replacing the birthweight information with respective ICD10
> codes which are currently missing in ICD10 version used in Georgia
> 
>   *   Grouping the data with NordDRG grouper (EST/FIN) (week 39).
>   *   Providing the preliminary results of the grouping to working
> group (via Skype, preliminary meeting agreed on 2nd Oct)
>   *   Providing feedback to SSA for additional check of certain 
cases
> with suspicious coding quality (50-100 cases), based on the grouping
> results (week 40).
>   *   Agree on next steps regarding cost analyses by using current 
SSA
> and providers’ tariffs (tbc).
> 
> 
> 
> Thank you once again and looking forward to getting the corrected 
data
> so that we can proceed with action our plan.
> 
> 
> 
> Regards,
> 
> Kristiina
> 
> 
> 
> 
> 
> 
> 
> ________________________________
> 
> From: Nino Berdzuli 
<[email-masked]<mailto:[email-masked]>>
> Sent: Friday, September 1, 2017 5:04 PM
> To: Triin Gmail
> Cc: [email-masked]<mailto:[email-masked]>; Zaza Sopromadze;
> Maia Khomeriki; [email-masked]<mailto:[email-masked]>;
> marina darakhvelidze; Ketevan Goginashvili;
> [email-masked]<mailto:[email-masked]>; Sarah Thomson;
> Marijan Ivanusa
> Subject: Re: DRG WG
> 
> 
> 
> Hi Triin,
> 
> 
> 
> Thanks for your email and reminder. Just to clarify, have you 
received
> data that was supposed to be send by August 31st?
> 
> 
> 
> Initial deadline August 20th for data requested was too optimistic
> given vacation times and amount of work related with data 
extraction.
> Let's plan to catch up next week - I will also ask Zaza.
> 
> 
> 
> Thanks!
> 
> Sent from my iPhone
> 
> On Sep 1, 2017, at 5:39 PM, Triin Gmail
> <[email-masked]<mailto:[email-masked]>> wrote:
> 
> Dear Nino and colleagues,
> 
> 
> 
> Hope you are all doing fine! Have you had a possibility to discuss 
the
> data query related issues and to check initial due date was too
> optimistic and we have to reconsider our initial action plan?
> 
> Just let us know if you have any questions you would like to discuss 
or
> if it would be helpful to have a quick call etc.
> 
> 
> 
> With all the best,
> 
> Triin
> 
> On 25 Aug 2017, at 17:14, Nino Berdzuli
> <[email-masked]<mailto:[email-masked]>> wrote:
> 
> Triin, thank you for a response and update. I very much hope that 
data
> extraction and requested data set will be available for your review
> next week.
> 
> 
> 
> I am asking Maia to check the progress on data extraction early next
> week and inform the group if there any challenges in this regard.
> 
> 
> 
> Happy weekend everyone!
> 
> 
> 
> Nino
> 
> Sent from my iPhone
> 
> On Aug 25, 2017, at 5:49 PM, Triin Gmail
> <[email-masked]<mailto:[email-masked]>> wrote:
> 
> Dear Nino and all others,
> 
> 
> 
> Formation of the working group is very much welcomed and definitely
> helps to better coordinate activities between ourselves to be timely 
in
> agreed activities and to discuss any obstacles that put timeliness 
into
> threat. Thank you for doing that!
> 
> 
> 
> Just a quick update of the recent developments. We got feedback from
> Maia that data preparation takes a bit more time than initially
> expected and hopefully data becomes available by next Thursday. At 
this
> stage we don't need to revise due dates of next activities but we 
can
> come back to that if data extraction is more challenging than was
> assumed. This can be a case as most probably this data query format 
is
> new for you and may need some more efforts. And if there are any
> questions related to data then don't hesitate to contact to 
Kristiina
> and me.
> 
> 
> 
> We could agree also the teleconference time after we have got a data
> and have had a first look on that.
> 
> 
> 
> Let's be in touch!
> 
> 
> 
> Best
> 
> Triin
> 
> On 24 Aug 2017, at 09:10, Nino Berdzuli
> <[email-masked]<mailto:[email-masked]>> wrote:
> 
> Dear Triin and Kristin,
> 
> 
> 
> Hope this e-mail finds you very well. Let me thank you both for a 
very
> productive mission, practical work/recommendations provided, next 
steps
> identified to start and advance DRG-related work. We are very much
> looking forward to working with you and make the best use of 
resources
> allocated through the UHC-Partnership program.
> 
> 
> 
> We have created DRG working group (in the cc) so that communication 
and
> exchange of information on DRG related work will be within this 
group.
> This will also help to track progress of on-going work. I am also
> enclosing in this e-mail translated in Georgian next steps/timelines 
to
> remind the group deliverables and deadlines.
> 
> 
> 
> Thanks again and look forward to hearing the work progress soon.
> 
> 
> 
> მოგესალმებით DRG-ის სამუშაო
> ჯგუფის წევრებს,
> 
> 
> 
> გთხოვთ ძირითადი
> კომუნიკაცია DRG-ისთან
> დაკავშირებით აწარმოოთ
> სამუშაო ჯგუფის ყველა
> წევრის ჩართულობის
> უზრუნველყოფით.
> 
> ასევე, მინდა შეგახსენოთ DRG
> -ის პროცესთან
> დაკავშირებული შემდეგი
> ნაბიჯები და დედლაინები
> რომელზეც შევთანხმდით
> კონსულტანტების ვიზიტის
> დროს (იხილეთ ბმულში).
> გთხოვთ, უზრუნველყოთ
> დედლაინების დაცვა.
> 
> 
> 
> გმადლობთ,
> 
> 
> 
> ნინო
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> Nino Berdzuli, MD, MPH
> 
> Deputy Minister
> 
> Ministry of Labor, Health and Social Affairs
> 
> 144 Tsereteli Ave
> 
> Tbilisi 0119, Georgia
> 
> Tel: +995 32 251 00 27 ext 0502
> 
> www.moh.gov.ge<http://www.moh.gov.ge>
> 
> 
> 
> 
> 
> 
> 
> <DRG next steps.docx>