J Clin Nutr.  2018 Jun;10(1):20-24. 10.15747/jcn.2018.10.1.20.

Quality Improvement Activities to Facilitate the Filing of Complexity Payment Claims for Patients with Malnutrition

• Kwon KH
• Lee HS
• Yoo JH
• Chi SN
• Park HH
• Kim SW
• Kim KR
• Yun NH
• Ra KT
• Song HJ

• KMID: 2437437
• DOI: http://doi.org/10.15747/jcn.2018.10.1.20

Abstract

PURPOSE
The grade of complexity in the diagnosis related group (DRG) payment system is influenced by the secondary diagnosis of specific complication and comorbidity level, in which moderate or severe malnutrition is included. This study examined an existing proportion of patients with malnutrition who were supposed to be qualified for the complexity level and devised quality improvement measures to increase the proportion of qualifying complexity payments.
METHODS
The goal of the activities was to increase the rate of complexity payment claims for patients with malnutrition (%). Cases ineligible for the DRG payment system and cases with no diagnosis of malnutrition were excluded. We established a collaborative system between the nutrition support team and departments related to each improvement factor (i.e., patient care, medical records, insurance review, and medical information).
RESULTS
Before implementing the activities, this study investigated the current level of complexity payment claims for malnutrition patients who were discharged within a specific period (June 1, 2015~August 31, 2015). The results showed that complexity payment claims were filed in 10.00% (2 of the 20 malnutrition cases). After the activities, the rate of complexity payment claims for the patients with malnutrition within the study period (June 1, 2016~August 31, 2016) was 46.43% (26 out of 56), showing an approximately 364% increase from the pre activity rate. This change was statistically significant according to the chi-square test on Microsoft Excel 2010 (P < 0.01).
CONCLUSION
Collaborative efforts by the related departments enabled the smooth implementation of each activity. In addition, moderate or severe malnutrition was revealed to be a variable in the complexity-specific payment system. In the future, hospital-wide awareness and effort are crucial to promot the steady practice of these activities and expand their implementation.

Keyword

Diagnosis-related groups; Complications; Comorbidity; Malnutrition

MeSH Terms

Comorbidity
Diagnosis
Diagnosis-Related Groups
Humans
Insurance
Malnutrition*
Medical Records
Patient Care
Quality Improvement*