As from 2005 the specialized complex rheumatologic treatment can be assigned to the code category 8-983 (Multimodale rheumatologische Komplexbehandlung) of the OPS procedure classification system. Only by means of this specific procedure code, has an appropriate description and consideration in the G-DRG system of the common clinical practice in specialized rheumatologic hospitals/clinics become possible. The complex and multimodal treatment reflects the rheumatologic therapeutic standard for the treatment of inflammatory rheumatic diseases and non-inflammatory pain syndromes. The article focuses on the minimal criteria that have to be met for coding the OPS 8-983. Helpful practical instructions are given concerning how to implement the complex procedure into practice. Even though the newly introduced procedure code OPS 8-983 will not yet develop influence on the grouping process in 2005, other changes in the GDRG system lead to an improved economic valuation of rheumatological services in comparison to 2004.
Starting with the second year of the so called "convergence period", specialized rheumatological treatment is now represented by a specific DRG (197Z) in the German G-DRG system. The definition of this DRG is based on the procedure codes for the complex and multimodal treatment of rheumatological inpatients (OPS 8-983 and 8-986). This will result in a more appropriate reimbursement of rheumatological treatment. The implementation of specialized rheumatological treatment can be regarded as exemplary for the incorporation of medical specializations into DRG systems. The first step is the definition of the characteristics by procedure codes, which can consequently be utilized within the grouping algorithm. After an inadequate representation of a medical specialization within the DRG system has been demonstrated, a new DRG will be established. As no cost data were available, the calculation of a cost weight for the new G-DRG 197Z is not yet possible for 2006. Hence, reimbursement has to be negotiated between the individual hospital and the budget commission of the health insurers. In this context, the use of clinical pathways is considered helpful.
Clinical pathways for three rheumatological indications have been successfully developed in the rheumatological departments of two hospitals. These diseases were selected because of the number of inpatients seen and/or the costs for diagnostics and therapy. Three quota-concepts, the coordination of treatment processes (quota-concept I), the sequence of implementing services (quota-concept II), and the economical utilization of available resources as well as the transparent definition of therapies (quota-concept III) have been established. These concepts have been tested individually as well as in complex situations.
The announced major reforms will most probably not have an impact on hospital financing before 2016. Nevertheless, the numerous minor changes in the legislative framework and the new version of the German diagnosis-related groups (G-DRG) system can be important for hospitals specialized in rheumatology. The following article presents the relevant changes and discusses the consequences for hospitals specialized in rheumatology.
The G-DRG system 2008 once again brings many changes to rheumatological departments in Germany. The following article presents the main general and specific changes in the G-DRG system, as well as in the classification systems for diagnoses and procedures and in invoicing for 2008. Since the G-DRG system is only a tool for the redistribution of resources, every hospital needs to analyze the economic effects of the system by applying the G-DRG transition grouper to its own cases. Depending on their clinical focus, rheumatological departments may experience positive or negative effects from the system's application. The strain placed on hospitals by the inadequate funding of increased costs needs to be assessed separately from the effects of redistribution by the G-DRG system.
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