G-DRG Version 2004: Veranderungen aus Sicht der Dermatologie. G-DRG Version 2004: Changes in view of dermatology

Extra length of stay and costs because of health care-associated infections at a German university hospital

BACKGROUND

Health care-associated infections (HAIs) can be associated with increased health care costs. We examined extra length of hospital stay (LOS) and associated per diem costs attributable to HAIs in a large academic medical center.

METHODS

Data for analysis were acquired in a preinterventional phase of a prospective cohort study (ALERTS) conducted over 12 months in 27 general and 4 intensive care units at Jena University Hospital. HAIs were identified among patients hospitalized for ≥48 hours with at least 1 risk factor for HAI and new antimicrobial therapy; the diagnosis was confirmed by U.S. Centers for Disease Control and Prevention criteria. Extra LOS was estimated by multistate modeling, and associated extra costs were based on average per diem costs for clinical units sampled.

RESULTS

Of a total of 22,613 patients hospitalized for ≥48 hours, 893 (3.95%) experienced 1,212 episodes of HAI during 12 months. The associated mean extra LOS ± SEM in general units was 8.45 ± 0.80 days per case and 8.09 ± 0.91 days for patients treated in both general and intensive care units. Additional costs attributable to HAIs were €5,823-€11,840 ($7,453-$15,155) per infected patient.

CONCLUSION

HAIs generated substantial extra costs by prolonging hospitalization. Potential clinical and financial savings may be realized by implementing effective infection prevention programs.

Development of lengths of stay and DRG cost weights in dermatology from 2003 to 2006

BACKGROUND

The G-DRG per case payments are calculated annually on the basis of present output and cost data provided from German hospitals. The economic valuation of dermatology-related DRGs depends largely on inpatients' length of stay. At present, longitudinal analyses of dermatologic hospital data considering the development of length of stay under DRG conditions are not available.

METHODS

A multicenter, longitudinal study of clinical data from hospitals with different care levels was performed (n = 23). Frequent and relevant dermatologic diagnoses were grouped and analyzed over a time period of four years (2003-2006). The development of lengths of stay and of G-DRG cost weights were studied in detail. Descriptive statistical methods were applied.

RESULTS

After introduction of DRG, the data reveal a) reduction of length of stay in inpatient dermatology and b) after an initial abrupt rise, DRG valuation of dermatologic groups moderately decreased over time. Both trends changed most rapidly in the early years but reached a stable niveau in 2006. The study furthermore points out that not only length of stay, but also other type of costs influence DRG calculations.

CONCLUSIONS

German dermatology reflects the international trend showing reductions of length of stay after introduction of a DRG-based hospital funding system. The DRG calculation and valuation of inpatient services depend on the duration of hospital stay. However, increasing per diem costs resulting from higher performances of every inpatient bed day are also taken into account. Further reduction of length of stay must not threaten the quality of inpatient care in dermatology.

Introduction of diagnosis-related groups in Germany: evaluation of impact on in-patient care in a dermatological setting

BACKGROUND

German diagnosis-related groups (G-DRG) have been introduced in Germany as a reimbursement system for in-patient care. The aim of this study was to report data-based experiences from the introduction process and to evaluate the impact on in-patient dermatology.

METHODS

A quantitative analysis including clinical data from two large university centres of dermatology over a time period of 4 years (2003-06) has been performed. Characteristics and trends of case-mix index, number of cases, average age, length of stay (LOS), surgical and medical treatments and in-patient case groups were studied in detail.

RESULTS

It was found that the case-mix index values increased after the introduction period, but subsequently declined on the initial value. At the same time, an increase of dermatological hospital admissions can be noticed parallel to a significant reduction of LOS (P < 0.001) and a moderate increase of average age (P < 0.001). Analysis of DRG assignment revealed an initial significant decline of surgical in-patient procedures and increasing medical treatments, however, without obvious long-term changes. Furthermore, a growing importance for dermatological oncology and inflammable skin diseases within the in-patient setting could be observed.

CONCLUSIONS

The introduction of the G-DRG system in Germany induced changes in in-patient care affecting hospital admission rates, LOS and cases treated in an in-patient setting. In-patient activities have not been reduced with the DRG introduction; however, long-term interdisciplinary research approaches are needed to explore the future impact on health care providing and quality of health care in depth.

Case mix measures and diagnosis-related groups: opportunities and threats for inpatient dermatology

OBJECTIVE

The changing healthcare environment world-wide is leading to extensive use of per case payment systems based on diagnosis-related groups (DRG). The aim of this study was to examine the impact of application of different DRG systems used in the German healthcare system.

METHODS

We retrospectively analysed 2334 clinical data sets of inpatients discharged from an academic dermatological inpatient unit in 2003. Data were regarded as providing high coding quality in compliance with the diagnosis and procedure classifications as well as coding standards. The application of the Australian AR-DRG version 4.1, the German G-DRG version 1.0, and the German G-DRG version 2004 was considered in detail. To evaluate more specific aspects, data were broken down into 11 groups based on the principle diagnosis.

MAIN OUTCOME MEASURE

DRG cost weights and case mix index were used to compare coverage of inpatient dermatological services. Economic impacts were illustrated by case mix volumes and calculation of DRG payments.

RESULTS

Case mix index results and the pending prospective revenues vary tremendously from the application of one or another of the DRG systems. The G-DRG version 2004 provides increased levels of case mix index that encourages, in particular, medical dermatology.

CONCLUSIONS

The AR-DRG version 4.1 and the first German DRG version 1.0 appear to be less suitable to adequately cover inpatient dermatology. The G-DRG version 2004 has been greatly improved, probably due to proceeding calculation standards and DRG adjustments. The future of inpatient dermatology is subject to appropriate depiction of well-established treatment standards.

G-DRG Version 2005: Relevante Aspekte fur die Dermatologie. G-DRG Version 2005: Relevant aspects for dermatology

One year after the obligatory implementation of a new hospital funding system based on Diagnosis Related Groups (DRG) the third version of a German DRG-system has been published. It differs significantly from the previous version. Modifications in the classification system and the introduction of further procedure-based payments contribute to a better depiction of specialized clinical services. A number of acknowledged problems which caused great discussion in 2004 have been solved, yielding a more appropriate mapping of clinical services. The algorithms of the major diagnostic categories have been modified and complications, comorbidities and/or multiple procedures will be considered more precisely in selecting a group. However, some inconsistencies concerning highly specialized medical procedures and special features of impatient dermatological care remain. Nevertheless, a great improvement over the previous versions is apparent. The crucial aspects of the G-DRG version 2005 and the accompanying rules and regulations of payment are reviewed in detail with special relevance to dermatology.

[DRGs in dermatology. A critical assessment]

The obligatory implementation of the DRG system in 2004 represents a fundamental change in German hospital financing. Since the first version of G-DRG catalogue was published, the final adaptation of the system to German clinical reality has consumed much time and energy. This adjustment has been very challenging for dermatology for a variety of reasons. A DRG evaluation project conducted by the German Society of Dermatology made possible improvements in the G-DRG catalogue 2004 from the perspective of dermatology. The hospitals now have to adjust to the new situation and to find their position in this system. A high coding quality is of greatest importance. When developing their clinical priorities, hospitals should not make the mistake of pursuing the temptations presented by the latest version of the DRG catalogue. Strategies of the practical use of the DRG system in hospitals are reviewed.

[Quality assessment of dermatology in the G-DRG system 2004]

BACKGROUND

Since January 2004, all German hospitals have been obliged to operate with a new hospital funding system based on DRGs. For the DRG system to serve as a fair basis for reimbursement requires that the dermatologic services be adequately covered in the classification system. The German Dermatologic Society (DDG) in cooperation with the DRG-Research Group of the University Hospital Muenster carried out a DRG evaluation study. Based on these results, suggestions for the adjustment of the G-DRG system were proposed by the DDG in the G-DRG adaptation round for 2004.

METHODS

Based on data of the DRG evaluation project (14,555 dermatological cases from 19 hospitals) the homogeneity in the G-DRG system 2004 was examined and compared with the quality of depiction in the G-DRG version 1.0.

RESULTS

The correlation between expenditure and case mix index in the hospitals improved in the G-DRG system 2004. Most proposals submitted by the German Dermatologic Society for the adaptation into the G-DRG system 2004 were accepted. Some fundamental problems such as reimbursement of high cost drugs and special services, as well as the reimbursement of high and low outliers, were only marginally addressed.

CONCLUSIONS

The G-DRG system 2004 will need to be continuously adapted in the field of dermatology. Based on this work, the German Dermatologic Society has made suggestions to be adapted in the G-DRG system 2005 and submitted them to the German DRG Institute.