DRG System Research Articles

Ökonomische Aspekte in der Intensivmedizin: Kosten und Reimbursement unter DRG-Bedingungen 2004

We analyse relevant modifications of the new German diagnosis related reimbursement system for 2004. It is difficult to judge the consequences of financing intensive care systems by such flat rates. In our surgical ICU total treatment costs were 1 050.-euro /day and 11 530.-euro /patient. Comparison of our total costs and German federal calculation 2003 for long-term ventilation revealed that our costs resulting from a tertiary unit topped the average by 36-60 %. Already the present reimbursement was not cost rewarding. Evaluation according to the 2003 criteria resulted in profound further deterioration to a cost covering of only 49 %. The 2004 system, however, allows for better differentiation of patients and should result in improved reimbursement of long-term ventilation. Further professional analysis of the DRG system is essential for its "learning" development.

Die Vidierkonferenz

The introduction of the German Diagnostic Related Groups (D-DRG) system requires redesigning administrative patient management strategies. Wrong coding leads to inaccurate grouping and endangers the reimbursement of treatment costs. This situation emphasizes the roles of documentation and coding as factors of economical success. The aims of this study were to assess the quantity and quality of initial documentation and coding (ICD-10 and OPS-301) and find operative strategies to improve efficiency and strategic means to ensure optimal documentation and coding quality. In a prospective study, documentation and coding quality were evaluated in a standardized way by weekly assessment. Clinical data from 1385 inpatients were processed for initial correctness and quality of documentation and coding. Principal diagnoses were found to be accurate in 82.7% of cases, inexact in 7.1%, and wrong in 10.1%. Effects on financial returns occurred in 16%. Based on these findings, an optimized, interdisciplinary, and multiprofessional workflow on medical documentation, coding, and data control was developed. Workflow incorporating regular assessment of documentation and coding quality is required by the DRG system to ensure efficient accounting of hospital services. Interdisciplinary and multiprofessional cooperation is recognized to be an important factor in establishing an efficient workflow in medical documentation and coding.

DRGs in dermatology. A critical assessment

The obligatory implementation of the DRG system in 2004 represents a fundamental change in German hospital financing. Since the first version of G-DRG catalogue was published, the final adaptation of the system to German clinical reality has consumed much time and energy. This adjustment has been very challenging for dermatology for a variety of reasons. A DRG evaluation project conducted by the German Society of Dermatology made possible improvements in the G-DRG catalogue 2004 from the perspective of dermatology. The hospitals now have to adjust to the new situation and to find their position in this system. A high coding quality is of greatest importance. When developing their clinical priorities, hospitals should not make the mistake of pursuing the temptations presented by the latest version of the DRG catalogue. Strategies of the practical use of the DRG system in hospitals are reviewed.

Diagnoseorientiertes Fallpauschalengesetz f�r Krankenh�user (DRG)

The implementation of the new system of hospital care, "G-DRG 1.0", has many problems. The responsibilities and demands of the introduction of DGRs are given from the standpoint of a university hospital, together with the demonstrated systematic errors and pitfalls within the current version the German DRG system. The deficits of the procedure for the calculation of the cost weighting are also outlined. Finally, the needs and critical issues of the new financing system will be targeted in the context of further DRG-development and hospital related long-term planning.

Komorbidität psychischer Störungen im G-DRG-System - Einfluss auf die Verweildauer und Erlössituation an einem deutschen Universitätsklinikum

The effect of comorbid mental disorders on the length of stay and revenue in a DRG system was investigated. For 33,189 cases of an university hospital (year 2002) the revenue based on a fictitious base rate was calculated, at first with and then without inclusion of diagnosed comorbid mental disorders. Furthermore, the effect of the latter on the length of stay was examined. Renunciation of diagnoses of mental disorders lead to an different DRG grouping in 7.9 % of cases and to a reduction in revenues of about 170.000. Minimal influence of comorbid mental disorders on the length of stay (R2 = 0.02) could be detected for single diagnostic groups. The lacking influence of comorbid mental disorders on the length of stay in a university hospital is mainly determined by the limited period of inpatient treatment and by the low frequency of diagnosed mental disorders. Therefore, a psychosocial consultation-liaison service is of major importance to guarantee the diagnosis and treatment of a comorbid mental (process quality) disorder and to guarantee adequate revenues in the G-DRG system (quality of structure).

Comparing systems for costing hospital treatments: The case of stable angina pectoris

This paper demonstrates the basic properties in the systems most commonly considered for costing treatments in the Danish hospitals. The differences between the traditional charge system, the DRG system and the ABC system are analysed, and difficulties encountered in comparing these systems are discussed. A sample of patients diagnosed with stable angina pectoris (SAP) at Odense University Hospital was used to compare the three systems when costing an entire treatment path, costing single hospitalisations and studying the effects of length of stay. Furthermore, it is illustrated that the main idea behind each system is reflected in how the systems over- or underestimate costs. Implications when managing the hospitals, particularly reimbursement, are discussed.

Hospital inpatient prospective payment system: incorporating new technology.

New technologies in the impatient prospective payment system are discussed. On December 21, 2000, Congress passed Public Law 106-554 that includes a requirement to establish a mechanism to more expeditiously incorporate the costs and establish qualifying criteria for payment of new services and technologies into the hospital inpatient prospective payment system. The final ruling of this law states that a new service or technology must demonstrate substantial improvement, be inadequately paid under the DRG system, and be "new." The intent of these criteria is to identify new technologies that offer substantial improvement over existing technologies and to provide supplemental payment that encourages physicians and hospitals to utilize the new technology. In November 2001, drotrecogin alfa (activated) received fast-track FDA approval because of the robust findings from the PROWESS trial. Drotrecogin alfa (activated) is the first agent proven to reduce mortality in patients suffering from severe sepsis associated with acute organ dysfunction who are at a high risk of death (i.e., APACHE II score > 24). In August 2002, drotrecogin alfa (activated) was one of four such new technologies and the first agent approved for new technology payment under the prospective payment system (PPS). This decision offers confidence that the PPS is effectively striving to incorporate new medical services and technologies at a pace similar to that of innovation. Providers may receive up to $3400 in additional reimbursement when drotrecogin alfa (activated) is administered in the Medicare population. Pharmacy and patient accounting personnel should develop a collaborative process to identify, document, and capture this new source of payment.

L’activité des services de médecine interne français en 2000–2001 à partir des données du PMSI

Purpose. – Medical activity of the French Internal Medicine Departments has been described until now only by limited declarative surveys. The aim of this study was to describe this activity using the French DRG system. Methods. – A postal survey was conducted using the list of the French Society of Internal Medicine. The same questionnaire was posted to 212 departments (university, public and private hospitals) to collect the 2000 or 2001 data from the DRG system. Results. – 192,197 reports were analysed. One hundred and eighty four groups were listed on a theoretical number of 313 medical groups. The first 10 groups concerned common general diseases (pneumonia, anaemia, heart failure, diabetes, stroke...). The main difference between university and non-university hospitals concerned the management of systemic diseases, which was more frequently quoted in university hospitals. Benign and malignant haematological diseases and oncology were frequently quoted in both types of hospitals. Conclusion. – This study allows for the first time in France to have an objective survey of the medical activity of Internal Medicine Departments. It confirms that these departments have a central role in the hospital management of current diseases but also of haematological diseases and cancer. University departments are more specifically implicated in the management of systemic diseases.

Assessing the impact of cost control strategies on Swedish physicians’ practice behaviour

Examines trends among Swedish physicians since the introduction of internal market reforms in the delivery of health care and assesses the impact of the use of a performance‐based reimbursement system on the practice of medicine. Explores the views of physicians with the use of the DRG system. The research data came from a mailed survey of physicians randomly selected from three major hospitals in Stockholm. Questionnaires were mailed between May 2001‐July 2001 to 100 physicians in active practice and the response rate was 46 per cent. The results suggest that these measures have affected the way physicians practice medicine. Physicians have become more cost‐conscious than before and most were less likely to recommend the profession to immediate family members. These findings are consistent with studies conducted by Forsberg on the impact of financial incentives on Swedish physicians. While some general dissatisfaction with working conditions was noted, most of the respondents were supportive of the reform measures initiated in Sweden.

Further development of the German DRG system--the position of the German Society for Rehabilitation of the Disabled

Further development of the German DRG system--the position of the German Society for Rehabilitation of the Disabled

DRGs in der Dermatologie: Erlösoptimierung durch Sicherung der Kodierqualität

Zusammenfassung Hintergrund: Die sachgerechte Abbildung der Behandlungsfälle im DRG‐System stellt die Grundlage der Vergütung für die durchgeführte Behandlung in deutschen Krankenhäusern dar. Dies kann nur über eine ausreichend gute Kodierung der medizinischen Daten ermöglicht werden. Ziel der vorliegenden Studie war, den Einfluß einer kontrollierten Leistungsdokumentation auf die klinischen Patientendaten zu untersuchen und die Auswirkungen einer verbesserten Kodierqualität auf die theoretischen Ertragsvolumina im australischen AR‐DRG‐System zu ermitteln. Patienten und Methodik: Im Rahmen einer prospektiven Studie sind 1 914 Patientendatensätze einer dermatologischen Universitätsklinik nach Anwendung unterschiedlicher Dokumentationsstandards auf der Basis des AR‐DRG‐Systems V4.1 gruppiert und analysiert worden. Zur besseren Differenzierung des dermatologischen Behandlungsspektrums wurden die Patienten in elf Behandlungsgruppen eingeteilt, um gezielter Schwerpunkte aufzeigen zu können. Ergebnisse: Durch eine kontrollierte Leistungsdokumentation konnten Steigerungen von Casemix, Casemix‐Index und mittlerem PKKS‐Wert erzielt werden. Ebenso zeigte sich, daßüber gesteuerte Maßnahmen zur Optimierung der Kodierqualität langfristig die tatsächliche durchschnittliche Fallschwere einer Klinik abgebildet werden kann. Schlußfolgerungen: Unterschiedliche Dokumentationsstandards können drastische Auswirkungen auf die Erlössituation eines Krankenhauses haben. Unvollständige Leistungsdokumentation, Fehl‐ und Überkodierung stellen ein großes ökonomisches Risiko für ein Krankenhaus dar. Nur die Sicherstellung und Überwachung einer hohen Kodierqualität kann eine kostendeckende Erlössituation garantieren.

Costs for acute, stationary treatment of polytrauma patients

Are the costs required for a polytraumatised patient sufficiently paid by the health care companies?The study population consisted of 71 polytrauma patients. The treatment-costs were calculated and compared with the reimbursements. The mean patient age was 38.0 years with a mean injury severity score (ISS) of 23.0 points. The mean duration of hospitalisation was 25.9 days and the mean calculated cost per patient was Euro 21,866.30. The reimbursement was only Euro 16,863.03/patient. This leads to a financial deficit of approximately Euro 5,000/patient (Euro 167/polytrauma patient/hospital day) and nearly Euro 355,000 for all patients during the period of 1 year. The introduction of the DRG system endangers the high standard of polytrauma treatment because of insufficient reimbursement.It is necessary to consider the implementation of an additional polytrauma-reimbursement based on the injury severity and duration of hospitalisation. The concentration of the patients in trauma centres, where the optimum of therapy is guarantied, leads in these hospitals to a continuously increasing deficit. The latter may be deleterious for the concept of "trauma centers" in the future.

DRG System

Journal of the American College of Surgeons: January 2002 - Volume 194 - Issue 1 - p 101-102 doi: 10.1016/S1072-7515(01)01124-3

DRG System

Journal of the American College of Surgeons 194(1):p 102-103, January 2002. | DOI: 10.1016/S1072-7515(01)01125-5

Comparison of DRG system funding and actual costs for intensive care in Hungary

Since its introduction in 1993, there has been continuous underfunding of the Heath System in Hungary; it is especially true for expensive specialties, like Intensive Care. In many other countries that use DRG costing, there is individual funding available for ICUs, but it is not the case in Hungary. In this study, we compared actual ICU costs with reimbursed funds during a 1-month period.

Diagnosis Related Groups (DRGs) in der Frauenheilkunde und Geburtshilfe

Structural and financial pressures in the German healthcare system have led to the decision at the national level to introduce diagnosis-related groups for most medical fields. This decision, to be implemented over the next 3 years, will challenge politicians as well as all groups of healthcare workers. The lack of a database and the lack of information for internal calculations and long-term planning mean that the infrastructural prerequisites for a DRG system are not in place. Thus, it is questionable whether the introduction of DRGs alone will ease the financial pressures in the German healthcare system. A decrease in quality is possible, particularly for fields like obstetrics and gynecology which have numerous therapeutic and diagnostic areas. Quality management and assessment measures will be required to address this problem.

PCV31: CLOSURE OF ATRIAL SEPTAL DEFECT: MEDICO-ECONOMIC ARGUMENTS TO CHOOSE BETWEEN INVASIVE SURGERY AND PERCUTANEOUS TECHNIQUE USING SEPTAL OCCLUDER

OBJECTIVES: The medical device implantation techniques via percutaneous aboard tend to substitute to surgical techniques, in various cardio-vascular therapeutics. However, prosthesis implantation is often accompanied high implementation costs (linked to the device acquisition) which are difficult to justify to the decision-maker, in a context of high financial constraint. METHOD: Available clinical data show similarity of effectiveness and complication rates between these two techniques. Therefore, the economic appraisal consists in a cost minimization approach. First, we modeled the two technique protocols before costing each action (personnel, facilities, … ) according to the internal costs of Grenoble hospital. Moreover, we estimated the budgetary productivity of these two strategies using the French DRG classification system used to adjust the annual financial allocation of French public hospitals. RESULTS: Results show the percutaneous technique (septal occluder Amplatzer®) is dominant (1.5 times less expensive than surgery), mainly by decreasing the hospital stay (two hospitalization days instead of 12 days in the surgery strategy). DRG system classification generates 1473 ISA (hospital productivity index) for the percutaneous technique and 7556 ISA for invasive surgery. CONCLUSIONS: Comparing between cost-minimization technic using internal costs and incremental budgetary impact using French DRG classification, we conclude that the prosthesis implantation via percutaneous aboard is economically dominant (cheaper than invasive surgery) but 5 times less contributive to annual budget allocation. Therefore incitation for the hospital decision-maker to use septal occluders must come with the adaptation to new technologies of financial public allocation using the DRG classification.

AR-DRG effects on geriatrics in Germany

The parties of the self-governing Health Service are at present preparing the introduction of a general case, flat rate compensation system for the hospital section on behalf of the legislature. The system is based on the performance definitions and case classifications of the Australian DRG System, Version 4.1. The relative evaluation of the individual DRG for the implementation into the system in Germany will be based on German cost and benefit data. For this purpose a calculation of case-specific treatment costs based on a representative selection of hospitals will be made. The geriatrics field will have to adapt itself to these regulations in the same way as all other medical disciplines. Difficulties are arising due to the inconsistent classification of cost and benefit data in connection with the classification. The geriatric field is under-represented in the calculation of relative evaluation and, therefore, the spectrum of benefit cannot be shown in the planned calculation system. Analogous to the calculation of German relative cost evaluation, the geriatric section will define in a project the actual costs for their treatment cases and determine the consecutive relative evaluation.

The impact of casemix on the care of the elderly.

The Australian Health care system is a mix of public and private provision. The Federal Government funds medical care and the pharmaceutical benefit scheme while the State Governments are responsible for funding the public hospitals. Geriatric Medical care is provided in the public hospital system. The Australian DRG system has evolved to more adequately explain illness severity by a greater use of the complications and comorbidities. The structure of the Sub-Acute and Non-Acute Patient (SNAP) classification is outlined. While it is anecdotally said that the introduction of DRG-based funding is detrimental to the elderly, the published evidence does not support this. The potential benefits of a casemix system are discussed.

Mathematical basis for large scale GIS and terrestrial digital products

The problem of spatial mathematical basis has been encountered by both large scale GIS and spatial digital products theoretically and practically. It is also a basic problem in the development of the whole geo-information science. After analyzing the status quo and the limitations of the space mathematical base of GIS, this paper points out definitely that the geodetic coordinate system is uniform, which can show the location of any point of the global exactly and uniquely in form of (B, L, H) and is the most proper reference system of largescale GIS and Digital Earth. Moreover, this paper also puts forward a set of practical model of the standard “map projection”. Finally, this paper introduces a DRG system based on this model.