Financing of complex replacement surgery

Abstract

In addition to the surgical demands of hip revision arthroplasty, the reimbursement of the different types of interventions represents amajor economic challenge for orthopaedic hospitals. With complex revision endoprostheses such as, for example, modular systems or custom-made implants, the flat-rate DRG is usually not sufficient to cover the costs generated and assure sufficient revenue. In Germany, the reimbursement of various replacement interventions in hip revision surgery has been differentiated and reduced in recent years and mostly not in favour of orthopaedic surgeons. Recently, the isolated cup exchange was substantially downgraded from the significantly better rated DRG I46B to the clearly lower rated DRG I47A. Isolated stem exchanges or complete exchanges of the entire endoprosthesis are sometimes only economically affordable for hospitals with supportive reimbursement by means of additional fees. An additional burden for hospitals in recent years has been the repeated deletion of additional OPS codes by insurance companies, which has led to the triggering of an additional fee. In summary, hip revision arthroplasty is an economically difficult terrain, in which cost coverage with appropriate reimbursement can only be achieved under the prerequisite of high case numbers, great experience and negotiation of adequate additional fees.