D Franz1, N Roeder, K Hörmann, J Alberty. 1. DRG-Research-Group, Universitätsklinikum Münster, Münster, Germany. dominik.franz@smc.uni-muenster.de
Abstract
BACKGROUND: To improve the representation of ENT medicine in the German diagnosis related groups (G-DRG) reimbursement system, the German Association for ENT Medicine and the ENT Professional Medical Association, in cooperation with the DRG-Research Group of the University Hospital of Muenster, undertook a DRG evaluation project. METHOD: A retrospective analysis was carried out of the DRG data records from 93,605 cases taken at 39 ENT institutions in 2003. A prospective collection of data from 25,666 cases, including defined expenditure data within a 4 month period in 2004, was also made. RESULTS: The number of cases per ENT institution ranged from 274 to 2,556. The mean case-mix was 792.0 and the mean case-mix index was 0.84. A total of 60.5% of the patients were male and 39.5% female, with an average age of 43.3 years. The mean patient clinical and complexity level (PCCL) was 0.72. Considerable adjustments have to be made, especially in oto-, rhino- and sinus-surgery. Allocation according to the complexity of the surgical procedure is mandatory and requires a revision of the German Catalogue of Medical Procedures. A DRG differentiation based on the PCCL should be implemented more frequently. Diagnostic endoscopies should be allocated via surgical partitioning. CONCLUSION: The adjustment proposals based on these results will gradually lead to an improved allocation of ENT medical procedures within the G-DRG system in 2006 and later.
BACKGROUND: To improve the representation of ENT medicine in the German diagnosis related groups (G-DRG) reimbursement system, the German Association for ENT Medicine and the ENT Professional Medical Association, in cooperation with the DRG-Research Group of the University Hospital of Muenster, undertook a DRG evaluation project. METHOD: A retrospective analysis was carried out of the DRG data records from 93,605 cases taken at 39 ENT institutions in 2003. A prospective collection of data from 25,666 cases, including defined expenditure data within a 4 month period in 2004, was also made. RESULTS: The number of cases per ENT institution ranged from 274 to 2,556. The mean case-mix was 792.0 and the mean case-mix index was 0.84. A total of 60.5% of the patients were male and 39.5% female, with an average age of 43.3 years. The mean patient clinical and complexity level (PCCL) was 0.72. Considerable adjustments have to be made, especially in oto-, rhino- and sinus-surgery. Allocation according to the complexity of the surgical procedure is mandatory and requires a revision of the German Catalogue of Medical Procedures. A DRG differentiation based on the PCCL should be implemented more frequently. Diagnostic endoscopies should be allocated via surgical partitioning. CONCLUSION: The adjustment proposals based on these results will gradually lead to an improved allocation of ENT medical procedures within the G-DRG system in 2006 and later.