A common language to manage risk and drive quality care

Jan. 8, 2020 / By Maja Sivertsen

Health ministries across the world wrestle with the same essential challenge: providing quality health care that is sustainable. To succeed, they must balance both the financial and clinical aspects of care. This balance calls for common, agreed-upon standards.

Let’s look at how Belgium meets this challenge for inpatient care.

Belgium is a small country with 11 million inhabitants. They have a mandatory health insurance system with all non-profit payers and a total annual healthcare expenditure of about $38 billion.

To achieve equitable, consistent reimbursement for services provided, the Belgian government uses 3M All Patient Refined Diagnosis Related Groups (APR DRGs) as a common language to set consistent parameters for payment. The APR DRG methodology provides a standardized way to classify patients by their reason for admission, severity of illness and risk of mortality.

Almost 90 percent of Belgian hospitals participate in a benchmarking program built around APR DRGs to compare themselves to other hospitals on parameters such as length of stay, potentially preventable complications and mortality. The benchmarking portal provides a shared reference point for both the financial and clinical sides of health care. It helps Belgian hospitals identify potential quality issues and prioritize efforts for improvement.

“Using APR DRGs, we can calculate an ‘expected’ value based on a hospital’s case mix and the risk of mortality parameter for each patient. This expected value is then compared to the ‘observed’ value to create a standardized mortality rate (SMR),” says Elric Verbruggen, MD, from 3M Health Information Systems’ Belgian subsidiary. Verbruggen’s principal job is to make sure Belgian clinicians and financial managers know how to leverage APR DRGs in their work. 

The APR DRG methodology identifies patients with multiple co-morbidities and complex secondary diagnoses. It accounts for risk according to hospital case mix. Care providers can then expect to be paid correctly and financial managers can budget resources based on specific care groups.

Used in Belgium for 15 years, the APR DRG methodology is also used in Spain, Portugal, Italy, the Canadian province of Quebec and by some hospitals in Brazil—not to mention broad application in the United States.

Listen to a short video interview with Elric Verbruggen from 3M Belgium where he highlights how patient methodologies like APR DRGs, PPCs and PPRs can provide actionable insights and drive the strategy and performance improvement in hospital operations.

To learn more about APR DRGs and how are they used in the U.S., as well as in Belgium, view our July 2019 webinar, “Creating a common inpatient language for value.”

Maja Sivertsen is International Business Development Manager at 3M Health Information Systems.