Thanks for sending requested contact info.

All the best New Year wishes for you and yours!

Nino

Dear Nino and colleagues,

 

Thank you a lot for a fruitful call during what we could go through the draft implementation plan and discuss some crucial points.

Based on that we had made changes in the plan, in TC mode, so that you can track them.

As we agreed, your will revise it once again and share with us. The aim should be to finalize the DRG implementation before the end of the year.

I also add here the phone number of Mr Martti Virtanen, CEO of Nordic Casemix Centre, +358 50 667 28. Hopefully you will get in contact with him asap.

 

Looking forward to receiving the revised implementation plan.

 

Thank you,

Kristiina 

 

---

From: Kristiina Kahur <kkahur@hotmail.com>
Sent: Tuesday, December 12, 2017 6:36 PM
To: Sopo Belkania; 'Nino Berdzuli'
Cc: 'Zaza Sopromadze'; 'Maia Khomeriki'; itabatadze@ssa.gov.ge; 'marina darakhvelidze'; 'Ketevan Goginashvili'; lashanikola@gmail.com; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com
Subject: Re: skype call

 

Dear Sopo,

 

Just after I had sent you the previous  email, I found your other email with updated suggestion from Junk Email folder.

So please ignore my previous email. 

I confirm that we can attend the Skype call on Friday, 15th of December at noon (Tbilisi time).

Sorry for confusion.

 

Thanks,

Kristiina

 

 

---

From: Sopo Belkania <sbelkania@moh.gov.ge>
Sent: Tuesday, December 12, 2017 4:38 PM
To: 'Kristiina Kahur'; 'Nino Berdzuli'
Cc: 'Zaza Sopromadze'; 'Maia Khomeriki'; itabatadze@ssa.gov.ge; 'marina darakhvelidze'; 'Ketevan Goginashvili'; lashanikola@gmail.com; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com
Subject: skype call

 

Dear all,

 

Ignore previous email.

 

We can arrange the skype call on Friday, 15 of December at 12:00 (Tbilisi time).

 

Please confirm your attendance.

 

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: Sopo Belkania [mailto:sbelkania@moh.gov.ge]
Sent: Tuesday, December 12, 2017 6:22 PM
To: 'Kristiina Kahur'; 'Nino Berdzuli'
Cc: 'Zaza Sopromadze'; 'Maia Khomeriki'; 'itabatadze@ssa.gov.ge'; 'marina darakhvelidze'; 'Ketevan Goginashvili'; 'lashanikola@gmail.com'; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; 'kurtsikashvilig@who.int'; 'kirvalidze.mariam@gmail.com'
Subject: RE: DRG WG (Analytical Report)

 

Dear Kristiina,

 

We could have the Skype call on Thursday, 14 of December - at 14:30 (Tbilisi time). You can call on Ninos skype.

 

 

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:kkahur@hotmail.com]
Sent: Friday, December 8, 2017 5:33 PM
To: Nino Berdzuli
Cc: Zaza Sopromadze; 'Maia Khomeriki'; itabatadze@ssa.gov.ge; 'marina darakhvelidze'; Ketevan Goginashvili; lashanikola@gmail.com; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com; sbelkania@moh.gov.ge
Subject: Re: DRG WG (Analytical Report)

 

Dear colleagues,

 

As we could not have the Skype call today, we would suggest the following time slots for new attempt: 

-next Thursday, 14 of December - between 9-12:30 (Tbilisi time) or between 14:30-18 (Tbilisi time)

-next Friday, 15 of December - between 9-13 (Tbilisi time).

Hopefully we can find a time suitable for all (or at least most) of us. 

Looking forward to receiving your feedback.

 

Thank you and have a nice weekend,

Kristiina

 

---

From: Kristiina Kahur <kkahur@hotmail.com>
Sent: Wednesday, December 6, 2017 3:17 PM
To: Nino Berdzuli
Cc: Zaza Sopromadze; 'Maia Khomeriki'; itabatadze@ssa.gov.ge; 'marina darakhvelidze'; Ketevan Goginashvili; lashanikola@gmail.com; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com; sbelkania@moh.gov.ge
Subject: Re: DRG WG (Analytical Report)

 

Dear Nino,

 

We had the preliminary look at DRG implementation plan and send you our commented version (please see attached). 

This is to provide you the opportunity to have a look at it already before our Friday call and prepare for discussion.

 

Thank you,

Kristiina 

 

---

From: Kristiina Kahur <kkahur@hotmail.com>
Sent: Tuesday, December 5, 2017 2:56 PM
To: Nino Berdzuli
Cc: Zaza Sopromadze; 'Maia Khomeriki'; itabatadze@ssa.gov.ge; 'marina darakhvelidze'; Ketevan Goginashvili; lashanikola@gmail.com; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com; sbelkania@moh.gov.ge
Subject: Re: DRG WG (Analytical Report)

 

Dear Nino,

 

Thank you for sharing with us the DRG implementation plan.

 

Looking forward to our Skype call on Friday.

 

Thanks,

Kristiina

---

From: Nino Berdzuli <nberdzuli@moh.gov.ge>
Sent: Tuesday, December 5, 2017 2:29 PM
To: Kristiina Kahur
Cc: Zaza Sopromadze; 'Maia Khomeriki'; itabatadze@ssa.gov.ge; 'marina darakhvelidze'; Ketevan Goginashvili; lashanikola@gmail.com; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com; sbelkania@moh.gov.ge
Subject: RE: DRG WG (Analytical Report)

 

Dear Kristiina and Triin,

 

Thank you for sending the final version of the report. I have shared this with the Minister, as well.

 

Enclosed is a DRG implementation plan, final draft at this point. But we will discuss details and comments related to this plan during the skype call.

 

Thanks and all the best,

 

Nino

 

From: Kristiina Kahur [mailto:kkahur@hotmail.com]
Sent: 2 December, 2017 18:03
To: Nino Berdzuli <nberdzuli@moh.gov.ge>
Cc: Zaza Sopromadze <zsopromadze@moh.gov.ge>; 'Maia Khomeriki' <maia.mariam@gmail.com>; itabatadze@ssa.gov.ge; 'marina darakhvelidze' <mdarakhvelidze@moh.gov.ge>; Ketevan Goginashvili <kgoginashvili@moh.gov.ge>; lashanikola@gmail.com; 'Sarah Thomson' <thomsons@who.int>; 'Marijan Ivanusa' <ivanusam@who.int>; 'HABICHT, Triin' <habichtt@who.int>; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com; sbelkania@moh.gov.ge
Subject: Re: DRG WG (Analytical Report)

 

Dear Nino and colleagues,

 

We have finalized the analytical report and are glad to share it with you.

Please find it attached (pdf and xls file).

The main changes compare to draft report are related to monitoring and reporting system (respective paragraph D under Main Findings, and Appendix 3 were added). In addition, the Conclusion part was revised based on the results of 15-17 Nov mission and Appendix 4 (draft DRG Implementation Plan) was added.

 

Looking forward to our Skype call next Friday, 8th of December, at 5pm (GEO time) to discuss the DRG implementation plan.

 

Thank you,

Kristiiina

 

---

From: Kristiina Kahur <kkahur@hotmail.com>
Sent: Saturday, November 4, 2017 7:13 PM
To: 'Nino Berdzuli'
Cc: 'Zaza Sopromadze'; 'Maia Khomeriki'; itabatadze@ssa.gov.ge; 'marina darakhvelidze'; 'Ketevan Goginashvili'; lashanikola@gmail.com; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com; sbelkania@moh.gov.ge
Subject: Re: DRG WG (Analytical Report)

 

Dear Nino et al,

 

Please find attached the analytical report “Using the Social Security Agency’s invoicing data for strategic purchasing, with a focus on DRGs” (it includes also the Excel table). This is a draft, so please do not quote or share it.

The information in this report is rather descriptive to enable the discussions about initial findings during the next mission and to work together with DRG working group before you make the final decision about moving towards DRG system.

In addition, concrete recommendations for improving the SSA’s data system and for moving towards a DRG system will be discussed during our next mission too. After the mission we will provide more detailed recommendations and the roadmap for DRG implementation.

 

Thank you,

Kristiina

 

 

---

From: Sopo Belkania <sbelkania@moh.gov.ge>
Sent: Friday, October 20, 2017 5:42 PM
To: 'Kristiina Kahur'; 'Nino Berdzuli'
Cc: 'Zaza Sopromadze'; 'Maia Khomeriki'; itabatadze@ssa.gov.ge; 'marina darakhvelidze'; 'Ketevan Goginashvili'; lashanikola@gmail.com; 'Sarah Thomson'; 'Marijan Ivanusa'; 'HABICHT, Triin'; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com
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, 26^th 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:kkahur@hotmail.com]
Sent: Friday, October 20, 2017 6:01 AM
To: Nino Berdzuli
Cc: Zaza Sopromadze; Maia Khomeriki; itabatadze@ssa.gov.ge; marina darakhvelidze; Ketevan Goginashvili; lashanikola@gmail.com; Sarah Thomson; Marijan Ivanusa; HABICHT, Triin; sbelkania@moh.gov.ge; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com
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 <nberdzuli@moh.gov.ge>
Sent: Saturday, October 14, 2017 5:39 AM
To: Kristiina Kahur
Cc: Zaza Sopromadze; Maia Khomeriki; itabatadze@ssa.gov.ge; marina darakhvelidze; Ketevan Goginashvili; lashanikola@gmail.com; Sarah Thomson; Marijan Ivanusa; HABICHT, Triin; sbelkania@moh.gov.ge; kurtsikashvilig@who.int; kirvalidze.mariam@gmail.com
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 <kkahur@hotmail.com> wrote:

Dear all,

 

As we agreed in our last Skype meeting (2^nd 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, 23^rd 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 23^rd of Oct before 15.30 would suit you the best.

 

Thanks,

Kristiina

 

 

---

From: Kristiina Kahur <kkahur@hotmail.com>
Sent: Monday, October 2, 2017 9:39 PM
To: Nino Berdzuli
Cc: Zaza Sopromadze; Maia Khomeriki; itabatadze@ssa.gov.ge; marina darakhvelidze; Ketevan Goginashvili; lashanikola@gmail.com; Sarah Thomson; Marijan Ivanusa; HABICHT, Triin; sbelkania@moh.gov.ge
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 <kkahur@hotmail.com>
Sent: Tuesday, September 19, 2017 5:08 PM
To: Nino Berdzuli
Cc: Zaza Sopromadze; Maia Khomeriki; itabatadze@ssa.gov.ge; marina darakhvelidze; Ketevan Goginashvili; lashanikola@gmail.com; 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).

1. CaseDistplayNumber is used. It’s a unique number and can be used later for linking additional data if needed.
   No action needed

2. Main diagnosis (column AA)

1. in 248 cases the main diagnosis is missing
   Action: to find the main diagnosis for those cases.
2. 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)

3. Secondary diagnosis (columns AB-AJ)

1. 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)

4. Procedure codes

1. There are 16 columns for procedure codes

1. NCSP_ძირითადი_2- NCSP_ძირითადი_8 (#7)
2. 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.

5. Gender (column C)

1. Information is there but it needs formatting
   Action: If male -> use 1, if female -> use 2, if unknown –> use 3

6. Age (column D)

1. AgeInDays, the age ranges from 0 to 35272 days (0-99 years) and should be ok
   No action needed

7. Discharge

1. For this the HospitalizationOutcome (column N) can be used. This information should be mapped to four different characters needed for grouping:

1. 1=any other including normal discharge to home or unknown
2. 2=transferred to another hospital
3. 3=left against medical advice
4. 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".

8. Length of stay (LOS)

1. Information is correct (minus one case).
   Action: Check the case 3310497435, were LOS is -5540.

1. Birthweight (column S)

1. 1170 cases with birthweight information in the data.
2. Birthweight ranges from 300g to 7000g? Is 300 and 7000g correct?
3. 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 22^nd Sept, if possible. If not, then by Monday 25^th 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 2^nd 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 <nberdzuli@moh.gov.ge>
Sent: Friday, September 1, 2017 5:04 PM
To: Triin Gmail
Cc: kkahur@hotmail.com; Zaza Sopromadze; Maia Khomeriki; itabatadze@ssa.gov.ge; marina darakhvelidze; Ketevan Goginashvili; lashanikola@gmail.com; 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 <triinhab@gmail.com> 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 <nberdzuli@moh.gov.ge> 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 <triinhab@gmail.com> 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 <nberdzuli@moh.gov.ge> 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