Impact of quality certification of multidisciplinary head and neck tumor centers

Ali Modabber,Anna Bock,Frank Hölzle,Kristian Kniha,Stephan Christian Möhlhenrich,Daniel Schick,Florian Peters,Marius Heitzer,Evgeny Goloborodko,Elke M. Schreiber

doi:10.1186/s12962-021-00273-9

Abstract

BackgroundCertification of multidisciplinary tumor centers is nowadays seen as the gold standard in modern oncological therapy for optimization and realization of guideline-based therapy and better outcomes. Single cases are reimbursed based on diagnosis-related groups (DRG). We aimed to review efficiency, cost analysis, and profitability following a certification.MethodsTumor board certification at the university hospital Aachen was implemented in 2013. We compared 1251 cases of oropharyngeal cancer treated from 2008 to 2017 before and after certification. For this purpose, several patient characteristics, surgery, and stay-related constants, as well as expenses and reimbursement heights were analyzed statistically.ResultsFollowing certification, the total case and patient number, surgery duration, hours of mechanical ventilation, case mix index points, DRG reimbursements as well as the costs increased significantly, whereas days of intensive care unit, amount of blood transfusions, patient clinical complexity level (PCCL) and the overall stay were significantly lowered. No changes were observed for the patient’s age and gender distribution. Also, the predetermined stay duration stayed constant.ConclusionsCertification of head-neck tumor centers causes a concentration of more complex cases requiring higher surgical efforts, which can be processed more efficiently due to a higher level of professionalism. Despite their benefits in cancer care, without compensation, centers may be struggling to cover their expenses in a system, which continuously underestimates them.

Highlights

To face challenges in times of rising medical expenses and to guarantee transparency and efficiency, the government of Germany introduced diagnosis-related groups (DRG) system in 2000, which aimed to sort hospital cases into medical and economical comparable groups [1, 2]
The final DRG takes the admission diagnosis, treatment procedures, and comorbidities, which are represented by the patient clinical complexity level (PCCL), into account and is further allocated into specific cost weight groups to generate the reimbursement height
Inclusion criteria for patients were met under the following conditions: oropharyngeal carcinoma, discharge between 2008 and 2017, presented in an multidisciplinary team (MDT) conference and tumor board, and the patient treated at the department of oral and maxillofacial surgery at the University Hospital Aachen from 2008 to 2017

Summary

Introduction

To face challenges in times of rising medical expenses and to guarantee transparency and efficiency, the government of Germany introduced diagnosis-related groups (DRG) system in 2000, which aimed to sort hospital cases into medical and economical comparable groups [1, 2]. In 2013 the department of oral and maxillofacial surgery at the University Hospital Aachen has been certified by the German Cancer Society carried out by OnkoZert. This implies a network of qualified, interdisciplinary, trans-sectoral facilities and if so, extending over locations, which displays the entire medical care for tumor patients [10, 11]. Certification of multidisciplinary tumor centers is nowadays seen as the gold standard in modern oncological therapy for optimization and realization of guideline-based therapy and better outcomes. We aimed to review efficiency, cost analysis, and profitability following a certification

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