[Economic profit of different injuries in a centre for hand surgery - replantation vs. amputation]

The Institute for Reimbursements in Hospital (InEK) annually provides an updated DRG system to ensure the medical service providers with a cost-covering remunera-tion. However, the underlying cost data are often opaque and disclosure of the basis of calculation does not take place. On the basis of cost and revenue data from our clinic between 2010 and 2012, a profit statement for amputations and replantation of one or more fingers was employed and compared with the nationwide data of the calculation clinics.

Inpatient days, the revenue and the costs incurred in our clinic based on the cost matrix of InEK costing manual [4] were determined for amputation (DRG X05B), replantation of one (DRG X07B) and several fingers (DRG X07A). The profit was calculated as the difference between revenues and costs. Further-more, a comparison of our data with the nationwide data of InEK was applied.

For each of the 3 DRGs the actual costs in our clinic were higher than the costs generated by InEK. Only amputation appeared profitable, while all limb-preserving interventions were associated with losses for our hospital. There was a clear discrepancy between the data of cost of InEK GmbH to the data of our clinic.

In order not to create any monetary disincentives at the expense of quality of care of individual patients, a cost-covering patient care for all case groups mentioned above should be ensured. The general distrust in the InEK's data that results from such a discrepancy in the cost data can only be rebutted by increasing transparency and disclosure of the calculation basis.