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Reimbursement by current German diagnosis-related groups system penalises complex congenital heart surgery

Nicodème Sinzobahamvya1, Thorsten Kopp2, Claudia Arenz1

  • 11 Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany.

Cardiology in the Young
|May 14, 2013
PubMed

Insights

The German Diagnosis-Related Groups system underfunds complex congenital heart surgery by 17%. Higher complexity cases, assessed by the Aristotle complexity score, face increasing financial penalties, highlighting a need for system adjustment.

Area of Science:

  • Cardiology
  • Health Economics
  • Healthcare Management

Background:

  • The German Diagnosis-Related Groups (G-DRG) system is used for hospital reimbursement in Germany.
  • Congenital heart surgery is a complex and costly procedure.
  • Accurate reimbursement is crucial for maintaining the quality of care for these patients.

Purpose of the Study:

  • To evaluate whether the current German Diagnosis-Related Groups (G-DRG) system adequately covers the costs associated with congenital heart surgery.
  • To determine the extent of underfunding, if any, in the G-DRG system for these procedures.
  • To explore the correlation between surgical complexity and reimbursement adequacy.

Main Methods:

  • Analysis of 458 hospital stays for congenital heart surgery in 2011.
  • Cost estimation based on guidelines from the Institute for the Hospital Remuneration System.
  • Reimbursement calculation using 2012 cost-weight values and additional compensations.
  • Classification of cases using the Aristotle complexity score (Levels 1-6).
  • Statistical analysis, including Spearman's rank correlation coefficient and regression analysis.

Main Results:

  • Mean hospital costs were €30,597, while mean reimbursement was €25,514, resulting in an overall underfunding of 17%.
  • Fifty-nine percent of cases were classified as higher complexity (Levels 4-6) according to the Aristotle complexity score.
  • Hospital costs strongly correlated with complexity levels (Spearman's r = 0.89).
  • Underfunding increased linearly with complexity, from 6% for Level 1 to 23% for Level 6 procedures.

Conclusions:

  • The current German Diagnosis-Related Groups (G-DRG) system increasingly penalizes complex congenital heart surgery.
  • The Aristotle complexity score is a valuable tool that could help to address the identified underfunding issues.
  • Reimbursement adjustments based on complexity are necessary to ensure adequate financial coverage for congenital heart surgery.

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