NYS Department of Health Release Revised DRG Weights
The NYS Department of Health (DOH) has released its revised analysis of new service intensity weights (SIWs) and length-of-stay (LOS) trimpoints applicable to NYS all-patient diagnosis-related groups (AP-DRGs). The State's 2007-08 budget required that the cost data used to compute the SIWs be updated to 2004, an important revision that was last performed in 1994. The AP-DRGs are used by the Medicaid program and many commercial payers for hospital inpatient reimbursement purposes. The SIWs are used to adjust inpatient payments to reflect the relative cost differences among services, while the LOS trimpoints are used in the Medicaid payment system to determine which cases qualify for short-stay or long-stay outlier payments. Among some of the changes seen in the new analysis, SIWs for newborn deliveries, particularly high-risk cases, increased in the aggregate and SIWs for substance abuse detoxification services decreased. There were increases and decreases in other major service areas as well as in the individual DRGs.
The revised SIWs will be implemented in the Medicaid program on a budget-neutral basis statewide, though there will be a redistribution among hospitals depending on their mix of cases. The budget legislation required that the new SIWs be implemented on Jan. 1, 2008, provided that certain other statutory conditions related to the analysis had been fulfilled. The NYS Commissioner of Health is authorized to phase in the new weights as long as they are fully implemented by Jan. 1, 2010. DOH plans to seek required regulatory approval for the changes at the Dec. 6, 2007, meeting of the State Hospital Review and Planning Council Fiscal Policy Committee.
GNYHA strongly supports using the most accurate and current data available to set payments but, with the Healthcare Association of New York State, had requested that DOH delay implementing the new weights because of concerns about significant methodological problems in the analysis that DOH released in June. GNYHA will be conducting a full analysis of the new SIWs and related impacts to determine whether there are other technical issues that need to be addressed before the SIWs and trimpoints are finalized.