DRGs in Transfusion Medicine and Hemotherapy in Germany

Abstract

Patients requiring transfusion medicine and hemotherapy in an inpatient setting are incorporated into the German Diagnosis Related Groups (G-DRG) system in multiple ways. Different DRGs exist in Major Diagnostic Category 16 for patients that have been admitted for the treatment of a condition from the field of transfusion medicine. However, the reimbursement might be not cost covering for many cases, and efforts have to be intensified to find adequate definitions and prices. We believe that this can only be successful if health service research is intensified in this field. For patients requiring hemotherapy and transfusion medicine concomitant to the treatment of an underlying disease such as cancer, multiple systems exist to increase remuneration, among them the Patient Clinical Complexity Level (PCCL) and complex constellations to induce DRG splits. For direct reimbursement of high cost products, additional remuneration fees (Zusatzentgelte, ZE) are the most important. In addition, expensive innovations not reflected within the DRGs can be reimbursed after application and negotiation of the New Diagnostic and Treatment Methods (Neue Untersuchungs- und Behandlungsmethoden, NUB) system. The NUB system guarantees that medical progress is put rapidly into clinical practice and prevents financial issues from becoming a stumbling block for the use of innovative drugs and methods.

Impact of quality certification of multidisciplinary head and neck tumor centers

“…A huge disadvantage of the DRG compensation is its retrospective approach, which adapts the reimbursement height annually to the costs of the previous years [ 27 , 32 ]. The broader implementation of additional charges (“Zusatzentgelte”) or new examination and treatment methods (NUB) for covering expensive procedures and products could facilitate the reimbursement of high-priced medicine and foster innovations, although there is little evidence so far [ 33 , 34 ]. Performance-based remuneration could additionally motivate to improve the efforts undertaken.…”

Ökonomie und Gerinnungsmanagement

“…Der Therapieaufwand ist nicht vorhersehbar und birgt immer ein finanzielles Risiko für das Krankenhaus. Durch das hohe Preisgefüge der Produkte kann der pauschale Fallerlös, der für die Patientenbehandlung vorgesehen ist, die Behandlungskosten oftmals nicht decken [22]. Eine Risikoabdeckung durch Fallpauschalen sieht das System nicht vor.…”

Retrospective Study on the Influencing Factors and Prediction of Hospitalization Expenses for Chronic Renal Failure in China Based on Random Forest and LASSO Regression

“…China is currently enacting new medical reform policies, and the medical insurance payment methods advocated by the National Medical Security Administration mainly include diagnosis-related groups (DRGs) and Diagnosis Intervention Packets (DIPs). As a payment tool that can effectively control increase in medical expenses ( 23 ), DRGs were conceived in the United States and rapidly developed worldwide. Diagnosis-related groups are based on patient age, sex, the length of hospital stay, factors such as clinical diagnosis, disease, surgery, disease severity, comorbidities, and complications, and outcomes, which divide patients into 500–600 DRGs, and then the amount of compensation that should be given to a hospital is determined.…”