Hostname: page-component-7c8c6479df-27gpq Total loading time: 0 Render date: 2024-03-28T08:36:58.558Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  13 May 2013

Nicodème Sinzobahamvya*
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
Thorsten Kopp
Affiliation:
Control Department, Asklepios Clinic, Sankt Augustin, Control Department, Asklepios Clinic, Germany
Claudia Arenz
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
Hedwig C. Blaschczok
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
Viktor Hraska
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
Boulos Asfour
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
*
Correspondence to: N. Sinzobahamvya, Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Arnold-Janssen-Strasse, 29, Sankt Augustin 53757, Germany. Tel: +49 2241249601; Fax: +49 2241249602; E-mail: n.sinzobahamvya@asklepios.com

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Quentin, W, Geissler, A, Scheller-Kreinsen, D, Busse, R. DRG-type hospital payment in Germany: the G-DRG system. Euro Observer, The Health Policy Bulletin of the European Observatory on Health Systems and Policies 2010; 12: 47. http://www.euro.who.int/en/who-we-are/partners/observatory/euro-observer/hospital-payment-systems-in-europe.Google Scholar
2. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911924.CrossRefGoogle Scholar
3. Heinrichs, J, Sinzobahamvya, N, Arenz, C, et al. Surgical management of congenital heart disease: evaluation according to Aristotle score. Eur J Cardiothorac Surg 2010; 37: 210217.CrossRefGoogle ScholarPubMed
4. Sinzobahamvya, N, Kopp, T, Photiadis, J, et al. Surgical management of congenital heart disease: correlation between hospital costs and the Aristotle complexity score. Thorac Cardiovasc Surg 2010; 58: 322327.Google Scholar
5. Sinzobahamvya, N, Photiadis, J, Kopp, T, et al. Surgical management of congenital heart disease: contribution of the Aristotle complexity score to planning and budgeting in the German Diagnosis-Related Groups system. Pediatr Cardiol 2012; 33: 3641.Google Scholar
6. O'Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 11391153.CrossRefGoogle ScholarPubMed
7. Jacobs, ML, O'Brien, SM, Jacobs, JP, et al. An empirically based tool for analyzing morbidity associated with operations for congenital heart disease. J Thorac Cardiovasc Surg 2013; 145: 10461057.Google Scholar
8. Mishra, V, Lindberg, H, Seem, E, et al. A comparison of hospital costs with reimbursement received for patients undergoing the Norwood procedure for hypoplasia of the left heart. Cardiol Young 2005; 15: 493497.Google Scholar
9. Cylus, J, Irwin, R. The challenges of hospital payment systems. Euro Observer, The Health Policy Bulletin of the European Observatory on Health Systems and Policies 2010; 12 (3): 14. http://www.euro.who.int/en/who-we-are/partners/observatory/euro-observer/hospital-payment-systems-in-europe.Google Scholar
10. Casale, PN, Thomas, GS, Gillam, LD et al. Paymentreform: current and emerging reimbursement models. American College of Cardiology 2011. Available at http://www.cardiosource.org/~/media/Files/Advocacy/Health%20Refrom/PaymentReformWhitePaper.ashx.Google Scholar
11. Sinzobahamvya, N, Photiadis, J, Arenz, C, et al. Congenital heart surgery: applicability of hospital reimbursement in German Diagnosis-Related groups system in conformity with the Aristotle complexity score. Thorac Cardiovasc Surg 2010; 58: 328332.Google Scholar