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Reimbursement by current German Diagnosis-Related Groups system penalises complex congenital heart surgery

Published online by Cambridge University Press:  13 May 2013

Nicodème Sinzobahamvya ,
Thorsten Kopp ,
Claudia Arenz ,
Hedwig C. Blaschczok ,
Viktor Hraska  and
Boulos Asfour
Nicodème Sinzobahamvya*
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
Thorsten Kopp
Affiliation:
Control Department, Asklepios Clinic, Sankt Augustin, Control Department, Asklepios Clinic, Germany
Claudia Arenz
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
Hedwig C. Blaschczok
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
Viktor Hraska
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Sankt Augustin, Germany
Boulos Asfour
Affiliation:
Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum, Sankt Augustin, Germany
*
Correspondence to: N. Sinzobahamvya, Department of Paediatric Thoracic and Cardiovascular Surgery, Deutsches Kinderherzzentrum Sankt Augustin, Arnold-Janssen-Strasse, 29, Sankt Augustin 53757, Germany. Tel: +49 2241249601; Fax: +49 2241249602; E-mail: [email protected]
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Abstract

A total of 458 hospital stays during the year 2011 were analysed to determine whether reimbursement by the current German Diagnosis-Related Groups system covers the costs incurred during hospital stay for congenital heart surgery. The costs of every hospital stay were estimated according to the guidelines of the Institute for the Hospital Remuneration System, an institute responsible for encoding hospital reimbursement in Germany. Cost-weight values of the year 2012 were applied for reimbursement. Related additional compensations were also included. Hospital costs ranged from 8896.26 to 193,671.94 euros per case, with a mean of 30,597 and standard deviation of 25,032 euros. Reimbursement varied from 8630.35 to 173,710.65 euros, with a mean of 25,514 and standard deviation of 18,497 euros: an underfunding of 17%. Fifty-nine per cent (271/458) of cases were classified, according to Aristotle complexity score, in higher comprehensive complexity: Levels 4–6. Costs highly correlated with complexity levels (Spearman's r coefficient = 0.89) and the regression was linear. Underfunding increased, linearly, from 6% for procedures with Level 1, lowest comprehensive complexity, to 23% for those with Level 6, highest complexity. In conclusion, this study demonstrates that reimbursement by the current German Diagnosis-Related Groups system increasingly penalises complex congenital heart surgery. Aristotle complexity score could help to correct this prejudicial situation.

Keywords

Congenital heart diseasehospital costs and fundingAristotle complexity score
Type
Original Articles
Information
Cardiology in the Young , Volume 24 , Issue 2 , April 2014 , pp. 344 - 350
Copyright
Copyright © Cambridge University Press 2013 

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