Empirical comparison of DRG variants using cardiovascular surgery data: initial results of a project at 18 German hospitals

Abstract

In 2000, the responsibility for selecting a DRG variant for use in Germany was assigned to a body comprising representatives of hospitals and insurers called the Self-Administration Board (or Board in this paper

The risk-adjusted vision beyond casemix (DRG) funding in Australia

“…Further severity markers identified in the current research might also be included in future regression specification, for example, brochiectasis and cardiomyopathy for lung and heart transplant related services, respectively.We turn now to the implications of the research for casemix classification and funding developments in Germany. [42].…”

“…Those particularly relevant to the current research concern the adequacy of the classification system including co-morbidities,complications,expensive and/or modern procedures,sensitivity to extreme cases and their relative size, cost homogeneity of the residual group,resistance of the system to gaming and cost homogeneity. An excellent detailed comparison of the underlying theories and constructions of the eight variants are provided by Rochell and Roeder [41] and Roeder et al [42]. They found that the French GHM-DRG and Australian AR-DRG variants had the best medical logic.The Australian system was outstanding regarding its explanation of its design and operation, and its statistical performance in resource use homogeneity.…”

“…An added advantage was the PCCL logic involving five levels of severity for every adjacent DRG based on additional diagnoses. Roeder et al [42] concluded that it could be recommended from the evidence on cardiac surgery,given its suitability for quality assurance,payment system, benchmarking and performance control.Another attraction was the open nature of its classification design, software implementation and the high level consideration of clinical logic over many years of refinement. The GHM variant, as with the AP-DRG, had a disadvantage regarding very heterogeneous groups and would require additional development to take account of variations such as the PCCL.…”

“…The GHM variant, as with the AP-DRG, had a disadvantage regarding very heterogeneous groups and would require additional development to take account of variations such as the PCCL. The HCFA variant did not adequately account for variations in severity and would require extension.R-DRG had virtually the same grouping results as HCFA-DRGs, although the more elaborate differentiation of complexity levels matches multiple morbidity more effectively [42]. The AR-DRG version 4.1 has been chosen as the basis for future German costing system for hospitals [26].…”

Cross‐national policy learning in health system reform: The case of Diagnosis Related Groups

“…Third, the documentation, as well as the “grouper” had already been translated (Leber, Schlottmann and von Stakkelberg, 2001). On the other hand, AR‐DRGs had performed better with respect to cost homogeneity and medical logic in a comparative evaluation of 18 German hospitals (Roeder et al., 2001). Moreover, the Australian government was prepared to make its grouper available for modification and enhancement, while the commercial AP‐DRGs could only be licensed.…”