Reimbursement by current German Diagnosis-Related Groups system penalises complex congenital heart surgery

Abstract

A total of 458 hospital stays during the year 2011 were analysed to determine whether reimbursement by the current German Diagnosis-Related Groups system covers the costs incurred during hospital stay for congenital heart surgery. The costs of every hospital stay were estimated according to the guidelines of the Institute for the Hospital Remuneration System, an institute responsible for encoding hospital reimbursement in Germany. Cost-weight values of the year 2012 were applied for reimbursement. Related additional compensations were also included. Hospital costs ranged from 8896.26 to 193,671.94 euros per case, with a mean of 30,597 and standard deviation of 25,032 euros. Reimbursement varied from 8630.35 to 173,710.65 euros, with a mean of 25,514 and standard deviation of 18,497 euros: an underfunding of 17%. Fifty-nine per cent (271/458) of cases were classified, according to Aristotle complexity score, in higher comprehensive complexity: Levels 4-6. Costs highly correlated with complexity levels (Spearman's r coefficient = 0.89) and the regression was linear. Underfunding increased, linearly, from 6% for procedures with Level 1, lowest comprehensive complexity, to 23% for those with Level 6, highest complexity. In conclusion, this study demonstrates that reimbursement by the current German Diagnosis-Related Groups system increasingly penalises complex congenital heart surgery. Aristotle complexity score could help to correct this prejudicial situation.

Reimbursement After Congenital Heart Surgery in Germany: Impact of Early Postoperative Extubation

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“…Underfunding was reported to be 23% for surgical repair or palliation of complex cardiac malformations. 1…”

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Fast-track extubation after cardiac surgery in infants: Tug-of-war between performance and reimbursement?

“…For each code, a specific fixed cost-weight value and an expected postoperative LOS are established. [22][23][24] A cost-weight value represents the amount of resources needed. That's why similar patient admissions with similar resource consumption should trigger similar reimbursement.…”

The impact of post-procedural complications on reimbursement, length of stay and mechanical ventilation among patients undergoing transcatheter aortic valve implantation in Germany

“…Under the German universal healthcare system, hospitals are reimbursed on the basis of a fee paid out according to the diagnosis under the German Diagnosis Related Groups (G-DRG) system. Fees are adjusted yearly based on expenditure data from a sample group of German hospitals and are subject to continuous calibration to accurately reimburse cost [9][10][11][12][13][14]. These databases represent a valuable source of national-level health economic data that has been used previously to examine other disorders [15,16].…”