FROM COST CONTAINMENT TO VALUE CREATION: INTEGRATING PATIENT-REPORTED OUTCOMES IN CARDIOLOGY REIMBURSEMENT...

Hospital reimbursement through Diagnosis-Related Groups (DRGs) is the dominant global model for enhancing cost containment and transparency. In cardiology, a field defined by rapid technological innovation and complex long-term outcomes, the DRG model faces a critical test: rewarding patient-centered value over procedural volume. The integration of Patient-Reported Outcome Measures (PROMs) represents the most significant evolution towards aligning reimbursement with measurable clinical and functional value. While Greece introduced its KEN-DRG framework in 2013, its potential has been hampered by static tariff calibration and a notable absence of outcome-linked payments. This narrative review aims to synthesize international evidence from leading DRG systems and propose a strategic roadmap for reform.

This study was designed as a comprehensive narrative review, an approach chosen to synthesise the heterogeneous and multidisciplinary body of evidence spanning clinical cardiology, health economics, public health policy, and health information technology. To ensure methodological rigour and transparency, the review process was guided by the principles outlined in the Scale for the Assessment of Narrative Review Articles (SANRA). A structured literature search was conducted using a systematic approach adapted for narrative reviews, following PRISMA guidelines.

The study revealed that while DRGs effectively reduce length of stay, cost misalignment persists for high-complexity interventions such as Transcatheter Aortic Valve Implantation (TAVI). Our findings showed that advanced healthcare systems in Sweden, Ger-many, and Australia are already leveraging PROMs to bridge this gap, linking funding to demonstrable improvements in patient well-being.

The study concludes that for Greece and similar systems, the integration of PROMs is an urgent necessity for achieving equitable, high-quality cardiac care. Key policy recommendations include the establishment of a national PROM registry, institutionalizing dynamic annual tariff recalibration, and enhancing coder certification, supported by modern digital auditing tools.