Financial Quality Control of In-Patient Chemotherapy in Germany: Are Additional Payments Cost-Covering for Pharmaco-Oncological Expenses?

Abstract

Background: Cost-covering in-patient care is increasingly important for hospital providers in Germany, especially with regard to expensive oncological pharmaceuticals. Additional payments (Zusatzentgelte; ZE) on top of flat rate diagnose-related group (DRG) reimbursement can be claimed by hospitals for in-patient use of selected medications. To verify cost coverage of in-patient chemotherapies, the costs of medication were compared to their revenues. Method: From January to June 2010, a retrospective costrevenue study was performed at a German obstetrics/gynecology university clinic. The hospital’s pharmacy list of inpatient oncological therapies for breast and gynecological cancer was checked for accuracy and compared with the documented ZEs and the costs and revenues for each oncological application. Results: N = 45 in-patient oncological therapies were identified in n = 18 patients, as well as n = 7 bisphosphonate applications; n = 11 ZEs were documented. Costs for oncological medication were € 33,752. The corresponding ZE revenues amounted to only € 13,980, resulting in a lossof € 19,772. All in-patient oncological therapies performed were not cost-covering. Data discrepancy, incorrect documentation and cost attribution, and process aborts were identified. Conclusions: Routine financial quality control at the medicine-pharmacy administration interface is implemented, with monthly comparison of costs and revenues, as well as admission status. Non-cost-covering therapies for in-patients should be converted to out-patient therapies. Necessary adjustments of clinic processes are made according to these results, to avoid future losses.

Comparison of Actual Hospital Costs versus DRG Revenues for In-Patient Treatment of Febrile Neutropenia during Adjuvant Anthracycline plus/minus Taxane-Based Chemotherapy for Primary Breast Cancer

“…A financially disadvantageousmaindiagnosiswasusedinn=4caseswith n=3C50.-breastcancerandn=1A49.9unspecifiedbacte-rial infection. The final DRG codes resulted in 7 Q-DRGs (table 2; 1-7), 3 J-DRGs (9-11) and 1 T-DRG (8). All QDRGs(n=7)werecostcoveringfromthehospital'sperspec-G-CSF and erythropoietin were used in 18.2% and 9.1% of episodes, respectively.…”

“…oncological medication [5][6][7][8] or breastimplants [3],especiallyinprophylaxis [9]andtreatment of febrile neutropenia [10][11][12] and also in clinical trials [13,14]. In a prospective study of primary breast cancer (pBC) patients receiving adjuvant anthracycline (A) ± taxane (T)-based CTX, the actual diagnostic and treatment costs were determined [10].TocompareandverifycostcoverageofinpatientFNtherapyfromtheprovider'sperspective,individual reimbursementsofDRGrevenueswerethereforecompared totheclinic'scostsinanindividualcase-basedanalysis.…”

Relevance of Health Economics in Breast Cancer Treatment: Integration of Economics in the Management of Breast Cancer at the Clinic Level

“…Based on and derived from this information, cost drivers can preferably be identified, and a cautious and gentile long-term optimization process can be induced towards a care-to-reimbursement adjustment. Over the years a variety of successful projects have evolved among them; optimizing chemotherapy reimbursement with reduction of oncological pharmaceutical costs by over 83% in just 2 years without changing quality of care [26,27,28], comparison of different chemoregimen [29], process analysis to discover mistakes in ordering, cost attribution, documentation, coding and billing for out-patient chemotherapies [30], prospective analysis of cost and reimbursement for participation in clinical trials [31], identification of off-label status for pharmaceuticals which are not reimbursed by statutory healthcare funds [32], analysis of costs and financial risks of expensive breast implants at 90% under-reimbursed in immediate breast reconstruction after mastectomy [33], prospective study of provider's costs of chemotherapy-related complications such as febrile neutropenia [34] and analysis and optimization of their correlating DRG reimbursement [35], prospective calculation of direct medication cost savings by biomarkers for avoiding chemotherapy in breast cancer at medium relapse risk [36], purchase and contract adjustments for reduction of costs of expensive breast ultrasound equipment to actual clinical needs [37], and identifying unexplainable reimbursement differences of mastectomy between prophylactic BRCA1/BRCA2 and breast cancer patients [38]. Even concordance of biomarker test results to Tumor Board decisions and final therapy can result in economic effects which can be used to optimize cost for their application [39].…”

“…As a consequence hospitals and breast centers have to analyze costs and reimbursements and adjust them accordingly to avoid potential losses which are not covered. Losses can occur from providing high-quality care in certified breast centers as calculated [43,44], from the use of expensive devices like breast implants which are not covered at 90.3% for immediate breast reconstruction after mastectomy [33], or from insufficient processes of chemotherapy reimbursement if not controlled [30]. At the present time the question is unsolved of how quality of care can be paid for [45,46].…”