[Management of the acute coronary syndrome under German diagnosis related groups in 2005/2006]
1Abteilung für Innere Medizin, St. Josefs-Krankenhaus Potsdam-Sanssouci, Potsdam.
Insights
German hospitals often delay percutaneous coronary intervention (PCI) for acute coronary syndromes due to reimbursement policies. Current Diagnosis Related Groups incentives do not prioritize timely PCI transfers, impacting patient outcomes.
Area of Science:
- Cardiology
- Health Economics
- Healthcare Policy
Context:
- Patients with acute coronary syndromes in Germany are frequently admitted to hospitals lacking percutaneous coronary intervention (PCI) facilities.
- This often results in significant delays in contact-to-balloon time, potentially increasing mortality and morbidity.
- The German Diagnosis Related Groups (DRG) reimbursement system may incentivize practices that exacerbate these delays.
Purpose:
- To discuss necessary changes in the German hospital reimbursement system concerning acute coronary syndrome (ACS) patient transfers.
- To analyze the reasons behind the lack of successful proposals for reimbursement reform by the German Cardiac Society.
- To examine the consequences of a reimbursement system driven by economic rather than medical considerations.
Summary:
- The German hospital reimbursement system, based on Diagnosis Related Groups (DRG), does not prioritize timely percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS).
- Hospitals may face financial disincentives for transferring ACS patients, and transport reimbursement is not covered.
- Proposed changes to the reimbursement system have been unsuccessful, as the volume of ACS transfer cases is deemed too small to justify economic adjustments.
Impact:
- The current reimbursement system may lead to suboptimal patient care for acute coronary syndromes due to economic, not medical, drivers.
- Delayed PCI can negatively affect patient mortality and morbidity outcomes.
- There is a need to align healthcare reimbursement policies with clinical best practices for critical conditions like ACS.
Abstract:
In Germany, patients with acute coronary syndromes are often primarily admitted to hospitals without PCI (percutaneous coronary intervention) facilities. It is known, that this leads to considerable delays in contact-to-balloon time, which may trigger enhanced mortality and morbidity of these coronary events. The new German hospital reimbursement system, which is based on Diagnosis Related Groups, may contribute by different incentives to this unadverted result. Hospitals gain more money, if patients remain longer, and admitting patients by transfer from other hospitals is less profitable than primary admittance. Transport reimbursement back to basic hospitals is not provided by public insurance. The German Cardiac Society has submitted proposals to recalculate the transfer cases of patients with acute coronary syndromes for several years without success. The present paper discusses possible and necessary changes in the reimbursement system. As a main result, the system will not be changed as proposed. The reason is, that-compared to the whole volume of hospital treatment cases-the volume of transfer cases with acute coronary syndromes is not large enough to justify changes in the reimbursement rules by economic considerations. The paper discusses the consequences of a hospital reimbursement system that can only be adapted to changed conditions by economic but not by medical reasons.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Acute Coronary Syndrome V: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care