Die Einführung des neuen DRG-basierten Entgeltsystems in Deutschen Krankenhäusern - Eine schwierige Operation?

Abstract

Until recently the costs of patients in German hospitals have mainly been calculated according to the length of hospital stay. However, in December 1999, a dramatic change was announced in the social laws in the "Gesundheitsreform 2000." Beginning in 2003 a prospective payment system based on the classification of the "Australian Refined DRGs (AR-DRG)" will be introduced. DRGs are already used in quite a lot of industrialized countries and basically are "per case" payment systems that group patients with homogeneous average costs based on the diagnoses and procedures performed in the hospital. When preparing for this new system, the clinician has a lot of additional tasks. Besides correctly documenting all clinical findings with the ICD-10 Diagnoses and the German OPS301 procedure codes, a knowledge of the economical impact of the clinical decision is absolutely crucial. The most important task is the optimizing of all clinical treatment processes (e.g. by the introduction of clinical pathways), because only hospitals that can do highly efficient treatment will be able to survive in the upcoming competitive situation. In the Krankenhaus München--Schwabing DRGs have been used as a benchmarking tool since 1997. Based on valuable experience, many direct measures to optimize efficiency have been taken. Especially in patients with multiple trauma, it became evident that the use of efficient and standardized treatment can bring economic gain without loss of quality.

Adverse Drug Reactions in Hospitalised Children in Germany Are Decreasing: Results of a Nine Year Cohort-Based Comparison

“…As anticipated with the introduction of DRGs [16], [17], [42] the length of hospitalisation significantly decreased between 1999 and 2008. Particularly the number of patients staying longer than 7 days in hospital decreased from 34% to 15.2%, respectively.…”

“…Contrary to previous methods this system is a case-based system, reimbursing hospitals for the treatment of patients based on the diagnosis and the procedures performed but independent of the length of hospital stay [16]. A reduction of the duration of hospital treatments was anticipated [17].…”

Guideline-adherent initial intravenous antibiotic therapy for hospital-acquired/ventilator-associated pneumonia is clinically superior, saves lives and is cheaper than non guideline adherent therapy

“…These data are primarily used for the annual evaluation and cost calculation within the German DRG-System (GDRG). These datasets are frequently used in clinical-economical analyses as they include all primary and secondary diagnoses (ICD-10 encoded) [19-24]. …”

Primäre Endoprothetik am Hüft- und Kniegelenk - Vergleich der Ist-Kosten mit den australischen Diagnosis Related Groups (DRG) -

“…Es ist damit zu rechnen, dass nach Einführung des DRG-Systems in Deutschland eine deutliche Aufenthaltsverkürzung eintreten wird. Diese war auch infolge der Einführung von DRG-Systemen in anderen Ländern zu beobachten [9,10]. Welche Liegezeit unseren Patienten zukünftig zustehen wird, hängt von der oben dargestellten Kalkulation ab, wenn kostendeckend gearbeitet werden soll.…”