gms | German Medical Science

Background: After legal implementation G-DRG system for hospital remuneration (“Fallpauschalengesetz”), German hospitals face a radical change of the modalities of reimbursement: In lieu of a former remuneration depending on the duration of hospitalisation a lump sum per case is paid. The amount paid for a specific patient depends on his principal diagnosis (HD), the structure of additional diagnoses (ND) and distinct medical procedures (OPS). In 2005, additional fees could be obtained by documenting expensive drugs (ZE). Only a complete, consistent and correct documentation ensures an adequate remuneration. The aim of this study was to proof the value of an on-site clearing to optimize the quality of the medical documentation.

Methods: The DRG relevant documentation of all dismissals in 2005of a dept. with 114 beds was controlled by direct interviews of the responsible physicians. Information obtained was cross-checked with the medical reports. Objectives were to verify the HD, to revise the appropriateness of the ND construct and to amend ignored OPS when necessary. ZE drug amounts have been recalculated and adapted when inadequate.

Results: The complete data for 2005 will be presented at the meeting. Approximative data shows that the annual turnover of ~ 25 Mil. € can be improved by 1,5 Mil. by adjusting former incorrect HD, ND, OPS and ZE documentation with the described clearing procedure. Diverse DRGs have been gererated in >10% of dismissals when a revision of the documentation was done. HD alteration was the main cause for data adjustment in 50 % of subjects. ZE documentation quality varied depending on the logistical system used for primary documentation.

Conclusion: The DRG system provides a differentiated reimbursement and depending on the medical efforts performed. However inadequate documentation directly leads to a deficient funding. The benefits resulting form a closed meshed clearing warrant the implementation of an effective medical controlling for every oncological department and regards both financial and quality issues.