N von Dercks1, A Völker2, E Schumann2, N H von der Höh2, C E Heyde2. 1. Stabsstelle Medizincontrolling, Universitätsklinikum Leipzig AöR, Liebigstraße 18, 04103, Leipzig, Deutschland. nikolaus.vondercks@uniklinik-leipzig.de. 2. Klinik u. Poliklinik für Orthopädie, Unfallchirurgie u. Plastische Chirurgie, Bereich Wirbelsäulenchirurgie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland.
Abstract
BACKGROUND: Spinal surgery is largely reimbursed in a differentiated manner via the DRG system. For treatments of complex paediatric deformities with increased pre and postoperative effort due to special treatment approaches, it seems that the costs for the treatment are not fully covered. MATERIALS AND METHODS: All paediatric cases with surgical treatment of the spine that were treated in a single spine centre from 2018-2020 were considered. The subgroup of patients with inpatient halo-gravity traction (halo group) before surgery was compared with all other cases treated in terms of economic and demographic factors. RESULTS: There were 86 cases that were treated surgically without halo traction and 6 cases with halo traction. The groups did not differ significantly in age (p = 0.41) or Patient Clinical Complexity Level (PCCL, p = 0.76). The average length of hospital stay in the halo group was significantly longer than in the other cases (84.2 ± 40.1 d vs. 11.0 ± 6.4 d; p = 0.001). Due to DRG grouping and long-stay surcharges, the mean revenue per case was significantly higher in the halo group than in the other cases (€ 63,615 ± 45,138 vs. € 16,836 ± 9356) (p = 0.003). The contribution margin for the period of the long-term surcharges varied between 11,394 and 9766 €. The high additional costs due to the necessary medical devices of halo traction were not sufficiently reflected in the reimbursement. CONCLUSION: Paediatric spine surgery can be challenging in special cases. In particular, severe deformities of the spine may require additional procedures. The subgroup of patients requiring preoperative halo traction is not adequately compensated by the DRG system.
BACKGROUND: Spinal surgery is largely reimbursed in a differentiated manner via the DRG system. For treatments of complex paediatric deformities with increased pre and postoperative effort due to special treatment approaches, it seems that the costs for the treatment are not fully covered. MATERIALS AND METHODS: All paediatric cases with surgical treatment of the spine that were treated in a single spine centre from 2018-2020 were considered. The subgroup of patients with inpatient halo-gravity traction (halo group) before surgery was compared with all other cases treated in terms of economic and demographic factors. RESULTS: There were 86 cases that were treated surgically without halo traction and 6 cases with halo traction. The groups did not differ significantly in age (p = 0.41) or Patient Clinical Complexity Level (PCCL, p = 0.76). The average length of hospital stay in the halo group was significantly longer than in the other cases (84.2 ± 40.1 d vs. 11.0 ± 6.4 d; p = 0.001). Due to DRG grouping and long-stay surcharges, the mean revenue per case was significantly higher in the halo group than in the other cases (€ 63,615 ± 45,138 vs. € 16,836 ± 9356) (p = 0.003). The contribution margin for the period of the long-term surcharges varied between 11,394 and 9766 €. The high additional costs due to the necessary medical devices of halo traction were not sufficiently reflected in the reimbursement. CONCLUSION: Paediatric spine surgery can be challenging in special cases. In particular, severe deformities of the spine may require additional procedures. The subgroup of patients requiring preoperative halo traction is not adequately compensated by the DRG system.
Authors: Avery Brown; Haddy Alas; Cole Bortz; Katherine E Pierce; Dennis Vasquez-Montes; Rivka C Ihejirika; Frank A Segreto; Jonathan Haskel; Daniel James Kaplan; Anand H Segar; Bassel G Diebo; Aaron Hockley; Michael C Gerling; Peter G Passias Journal: J Clin Neurosci Date: 2020-12-28 Impact factor: 1.961
Authors: Christoph Eckhard Heyde; Matthias Krause; Jan-Sven Gilbert Jarvers; Ulrich Josef Albert Spiegl; Anna Völker; Stefan Glasmacher; Christoph Josten; Nicolas H von der Höh Journal: Z Orthop Unfall Date: 2019-11-27 Impact factor: 0.923
Authors: Karsten Ridderbusch; Alexander S Spiro; Philip Kunkel; Benjamin Grolle; Ralf Stücker; Martin Rupprecht Journal: Dtsch Arztebl Int Date: 2018-06-01 Impact factor: 5.594