Cost Accounting Implications of Surgical Learning in the DRG Era — Data Evidence from a German Hospital

Abstract

On January 1st 2004, Germany introduced a prospective payment system for the reimbursement of almost all inpatient hospital cases. The new system, which is based on Diagnosis Related Groups (DRGs), is now mandatory for all hospitals that treat patients insured under Germany's statutory health insurance system (GKV). Although most German hospitals are currently exerting great efforts to calculate their individual DRG-costs, concerns have been raised whether such a system of administered fixed prices will be able to cope with medical innovation or quickly become obsolete. To gain insights into this question, an analysis of the dynamic properties of medical process innovations and their possible impact on the DRG system which is based on actual German data seems clearly merited. For two important medical innovations of the last two decades, a new method of knee replacement surgery and minimally invasive gall bladder removal (laparoscopic cholecystectomy), we empirically explore the question of whether the important cost driver "procedure time" displays a learning effect that accords with classical learning curve theory. Our principal results suggest that for these two high-cost, high-volume procedures, individual and organizational learning does indeed take place in the operating room. Based on these empirical results, we discuss our findings' implications for hospital cost accounting in the era of DRGs.