TY - JOUR
T1 - A qualitative study of DRG coding practice in hospitals under the Thai Universal Coverage Scheme
AU - Pongpirul, Krit
AU - Walker, Damian G.
AU - Winch, Peter J.
AU - Robinson, Courtland
N1 - Funding Information:
The conduct of this study would not have been possible without participation of all respondents and research assistants. The authors also would like to thank Paulina Sockolow and Sureerat Ngamkietpaisarn for their kind comments during the manuscript preparation. This study is a part of the first author’s dissertation project “Hospital Coding Practice, Data Quality, and DRG-based Reimbursement under the Thai Universal Coverage Scheme”, which received partial financial support from the Health Insurance System Research Office (HISRO), Thailand. He also received one of the Higher Educational Strategic Scholarships for Frontier Research Network from The Commission on Higher Education, Thailand.
PY - 2011
Y1 - 2011
N2 - Background: In the Thai Universal Coverage health insurance scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group-based retrospective payment, for which quality of the diagnosis and procedure codes is crucial. However, there has been limited understandings on which health care professions are involved and how the diagnosis and procedure coding is actually done within hospital settings. The objective of this study is to detail hospital coding structure and process, and to describe the roles of key hospital staff, and other related internal dynamics in Thai hospitals that affect quality of data submitted for inpatient care reimbursement. Methods. Research involved qualitative semi-structured interview with 43 participants at 10 hospitals chosen to represent a range of hospital sizes (small/medium/large), location (urban/rural), and type (public/private). Results: Hospital Coding Practice has structural and process components. While the structural component includes human resources, hospital committee, and information technology infrastructure, the process component comprises all activities from patient discharge to submission of the diagnosis and procedure codes. At least eight health care professional disciplines are involved in the coding process which comprises seven major steps, each of which involves different hospital staff: 1) Discharge Summarization, 2) Completeness Checking, 3) Diagnosis and Procedure Coding, 4) Code Checking, 5) Relative Weight Challenging, 6) Coding Report, and 7) Internal Audit. The hospital coding practice can be affected by at least five main factors: 1) Internal Dynamics, 2) Management Context, 3) Financial Dependency, 4) Resource and Capacity, and 5) External Factors. Conclusions: Hospital coding practice comprises both structural and process components, involves many health care professional disciplines, and is greatly varied across hospitals as a result of five main factors.
AB - Background: In the Thai Universal Coverage health insurance scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group-based retrospective payment, for which quality of the diagnosis and procedure codes is crucial. However, there has been limited understandings on which health care professions are involved and how the diagnosis and procedure coding is actually done within hospital settings. The objective of this study is to detail hospital coding structure and process, and to describe the roles of key hospital staff, and other related internal dynamics in Thai hospitals that affect quality of data submitted for inpatient care reimbursement. Methods. Research involved qualitative semi-structured interview with 43 participants at 10 hospitals chosen to represent a range of hospital sizes (small/medium/large), location (urban/rural), and type (public/private). Results: Hospital Coding Practice has structural and process components. While the structural component includes human resources, hospital committee, and information technology infrastructure, the process component comprises all activities from patient discharge to submission of the diagnosis and procedure codes. At least eight health care professional disciplines are involved in the coding process which comprises seven major steps, each of which involves different hospital staff: 1) Discharge Summarization, 2) Completeness Checking, 3) Diagnosis and Procedure Coding, 4) Code Checking, 5) Relative Weight Challenging, 6) Coding Report, and 7) Internal Audit. The hospital coding practice can be affected by at least five main factors: 1) Internal Dynamics, 2) Management Context, 3) Financial Dependency, 4) Resource and Capacity, and 5) External Factors. Conclusions: Hospital coding practice comprises both structural and process components, involves many health care professional disciplines, and is greatly varied across hospitals as a result of five main factors.
KW - DRG Creep
KW - Diagnosis Related Group
KW - Hospital Coding Practice
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U2 - 10.1186/1472-6963-11-71
DO - 10.1186/1472-6963-11-71
M3 - Article
C2 - 21477310
AN - SCOPUS:79953735829
SN - 1472-6963
VL - 11
JO - BMC health services research
JF - BMC health services research
M1 - 71
ER -