[Development of DRG-reimbursement in hand surgery]

Since the introduction of Diagnosis Related Groups (DRGs) in 2004 in Germany the variables of remuneration changed continuously. Subjectively, reimbursement of DRG in hand surgery has a negative connotation among colleagues. We analyzed the development of reimbursement as well as the length of stay of inpatients over time in Hand Surgery considering various parameters concentrating on trends and correlation with macroeconomic parameters. The Top 10 diagnoses and therapies between 2004 and 2010 in our clinic were grouped and resulting DRGs with further linked data could be obtained. In addition to the Base Rate the Pay Base Rate (the effective Base Rate in a certain hospital considering compensatory payment) and the Z-Bax (the value that was reimbursed by the national health insurance per Base Rate) were used to calculate reimbursement. These were multiplied with the number of cases treated in 2009 obtaining the different total annual remuneration. The lower threshold of length of stay was constant over time, the middle length of stay became shorter in most of the Top 10 diagnoses whereas the upper threshold of length of stay was reduced to half of the time. The Base Rate and the Pay Base Rate increased by the end of the period but were outmatched by the Z-Bax as an indicator for the general level of reimbursement in Germany. Total remuneration between 2004 and 2009 was compared applying the Z-Bax and the Base Rate as well as the Pay Base Rate, respectively. For the latter, a surplus of 244 000 Euros and 311 000 Euros were calculated, respectively. No correlation with the Gross National Product or the Rate of Inflation could be found. The Pay Base Rate as the rate of effective payment in our clinic declined by 7% whereas the consumer price index gained 8,6% resulting in a loss of purchasing power of almost 16% in a 6-year period.