gms | German Medical Science

Objective: Financial resources of today's medical practice are profoundly limited. To regulate the reimbursement process, the DRG system (Diagnosis Related Groups) has been stipulated in Germany in January 2004. It is an economic and medical system to classify hospital cases into groups based on diagnoses and procedures. Essential for adequate reimbursement is a complete acquisition of diagnoses, procedures, complications and comorbidities. Representatives of the health insurance regularly audit relevant diagnoses or procedures on site. To match the increasing challenges of this complex system, our department has recently recruited a board certified neurosurgeon for a part-time position as DRG controller The goal of our study was to demonstrate the impact of this management executive on the reimbursement rate and financial balancing of a academic neurosurgey department.

Method: Since June 2009 a 50 % part-time position is assigned to a board certified neurosurgeon being responsible for financial controlling. This includes both coding of all cases and vindicating the financial claims towards the health insurances. In addition hospitalization and in-patient treatment has been optimized with regard to length of stay. We compared the first two years of professional coding to the last two years before concerning number of cases, length of stay, number of secondary diagnoses, number of procedures, case mix index (CMI) and health insurances' reclaims.

Results: The quantity of secondary diagnoses per case (2007: Ø 2,9; 2008: Ø 2,6; 2009: Ø 3,6; 2010: Ø 4,9 ; 2011: Ø 6,0) and quantity of procedures per case (2007: Ø 8,5; 2008: Ø 8,9; 2009: Ø 8,8 ; 2010: Ø 9,7 ; 2011: Ø 9,4) increased and the CMI boosted from 2,35 in the year 2007 to currently 3,215. Nevertheless the number of cases (2007-2011: Ø 1586 cases/year) and length of stay (2007-2011: Ø 10,6 days) remained stable. The verifications of the health insurance resulted in an evident improvement, as well: cost weight points (CW) won: 64,95 % in 2008, 78,20% in 2009, and 94,17% in 2010. This means that 863.481,47 € could be retained out of health insurance reclaims of 916.912,96 € in 2010.

Conclusions: Although number of cases and length of stay were constant complete acquisition of relevant parameters resulted in an increasement of CMI. Hence, the investment in a neurosurgically qualified DRG controller is profitable, also with regard of health insurance demands.