German DRG Research Articles

Procedure optimization in hospital management

Starting January 1st 2004 the German diagnosis-related group (DRG) system was established for in-patient cases. Consequently, the detection and realization of cost-saving potentials are becoming more and more important. For a successful future, efficient allocation of resources is essential. Economically, anaesthesia-related time delays during perioperative work-flow should be minimized. Since numerous entities contribute to perioperative care, it is extremely complex to analyze and optimize this process flow. In this publication single steps leading to an optimized perioperative process flow will be presented: documentation of predefined time points, calculation of relevant time intervals and analysis of key numbers for complex settings. Single steps of the given process analysis will be demonstrated using data from surgical patients at the University Hospital Schleswig-Holstein, Campus Kiel. The attached data collection sheets can be used by interested hospital departments and are meant to serve as a template for further process analyses. Based on the shown analysis, an example will be given to develop an optimized work-flow as a standard operating procedure (SOP). The implementation of the SOP module in an interdisciplinary clinical pathway (CP), which defines efficient medical care from admission to discharge, is mainly responsible for decreased process costs but increased quality of care.

Evaluating the first German diagnosis-related groups (G-DRG) in cardiological patients: problems in the correct medical and economic grouping

About three years ago, the German Government initiated a complete change in the reimbursement system for costs of the in-hospital treatment of patients. A commission of representatives from every component of the German health system decided to adapt the Australian refined Diagnosis Related Groups (AR-DRG system). The AR-DRG system was selected as it would fit best to the German system and because of its high flexibility and preciseness reflecting severity of diseases and treatments. In October 2002, the first German Diagnosis Related Groups (G-DRGs) were calculated from the data of about 116 hospitals. These data now allow first analyses in how far a correct and precise grouping of patients in specific hospital settings is indeed performed and corresponds to the actual costs. Thus, we thoroughly calculated all costs for material and personnel during the in-hospital stay for each patient discharged during the first 4 months of 2002 from our cardiological department. After performing the grouping procedure for each patient, we analyzed in how far inhomogeneous patient distribution in the DRGs occurred and which impact this had on costs and potential reimbursements. Several different problems were identified which should be outlined in this work regarding three G-DRGs: costs of patients who received an implantable cardioverter defibrillator (F01Z) were markedly influenced by multimorbidity and additional expensive interventions which were not reflected by this G-DRG. Use of numerous catheters and expensive drugs represented a major factor for costs in patients with coronary angioplasty in acute myocardial infarction (F10Z) but seemed to be not sufficiently included in the cost weight. A specific area of patient management in our department is high frequency ablation of tachyarrhythmias which is included in other percutaneous interventions (F19Z). Complex procedures such as ablation of ventricular tachycardia or new innovative procedures as ablation of atrial fibrillation were associated with high costs leading to inadequate reimbursement. Furthermore, problems in the associated codes for diseases and procedures became apparent. Opportunities for future optimization such as specific new DRGs, splitting of DRGs, or the impact of changes in reimbursement for high-outliers were discussed.

German diagnosis-related groups. Problems in the field of mental and behavioural disorders shown in the example of hospital treatment of alcoholics

Hospital treatment in Germany will clearly change: instead of paying by the number of days, blanket prices including all necessary benefits will become the norm. The nearly innumerable treatments possible were collected into diagnosis-related groups (DRGs) requiring similar clinicomedical benefits and consuming similar financial resources. The DRG classification in Germany (G-DRG) will be oriented to the Australian refined diagnosis-related group (AR-DRG) system, which has existed since 1998. German psychiatric hospitals have by policy not yet been involved in the new system. However, a big sector of psychiatric activity--as far as number of patients is concerned--has already been incorporated in this new system: detoxification from legal and illegal drugs is involved in G-DRG inasmuch as it does not take place in psychiatric hospitals. If the DRG system becomes established in German psychiatric hospitals, grave difficulties will occur. These problems are described together with the expected results in the example of hospital treatment of alcoholics.

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

A DRG based future hospital funding scheme: state of implementation and impact in the field of rehabilitation

With the statutory health insurance reform act 2000 the German government started to introduce a new hospital funding system based on an internationally used diagnosis related groups (DRGs) system. In June 2000 the German self-administration board (consisting of the German hospital federation, the German statutory health insurance funds and the association of private health insurers), which is in charge of realizing this project, decided to develop the future German (Refined) DRG System (G-DRG) with reference to the Australian Refined DRG System (AR-DRG) Version 4.1. Replacement of the previous German hospital reimbursement system by the new DRG-based hospital funding system is planned for January 2003 on a voluntary basis. From January 2004 on, the change of the reimbursement system is to become mandatory for all hospitals with the exception of psychiatry. The new reimbursement system is intended to not only cover acute hospital care but also parts of early rehabilitation, palliative and sub-acute care. Because of its economic incentives the effects of DRG introduction in Germany will not only be limited to the hospital scene but will also affect rehabilitation.

What consequences will have the introduction of German Diagnosis Related Groups (G-DRGs) in surgical departments?

With the planned introduction of Diagnosis related groups (DRG) in the German in-patient reimbursement system an economic brake will be put on the hospitals. The upcoming expected growth of the older German population and the ongoing process of better diagnostic and therapeutic procedures leads to a gap between costs and resources in the established health care system. With the introduction of the DRGs starts a process of one payment for one main diagnosis in hospital care. This requires a better resource control and leads to a tightrope walk between medical and economic aspects. The short time consequences result in great efforts of correct coding of diagnoses and procedures, as a survival strategy for surgical departments. More or less are new structures necessary, the development of "clinical pathways" and the increase or decrease of capacities will become the main tasks in the next years.