DRG-basierte Erlösentwicklung in der Orthopädischen Chirurgie: Die vergleichende Entwicklung der Relativgewichte und Patientenverweildauern in Deutschland (aktueller G-DRG V1.0) und in australischen Lehrkrankenhäusern (AR-DRG 4.1) am Beispiel Endoprothetik, Wirbelsäulen-, Schulter- und Fusschirurgie

Study goal: In September 2002 the Federal Ministry of Health (BMG) has passed a decree in respect to the diagnosis related group system (G-DRG) for German hospitals (KFPV). From 2003 on the basis of this decree German hospitals were offered for the first time to use the G-DRG system optionally according to the 17b Abs.4 of the Hospital Financing Law ( Krankenhausfinanzierungsgesetz - KHG). In addition the preliminary calculation data for the German DRG-System were published. The goal of this study was to compare the development of the cost weights and the average lengths of hospital stay in Australian teaching hospitals between 1998 and 2001 with the cost weights and average lengths of hospital stay in German hospitals according to the data published in the first German calculation (G-DRG V1.0). Methods: An analysis was performed using the publically accessible reports on the national hospital cost data collections from 1998 until 2001 as they were published by the Commonwealth Department of Health and Aged Care in Australia. These data were compared with the cost weight calculation and average lengths of hospital stay calculation of the Institute for the Assessment of Cost Weights (InEK GmbH) published in the G-DRG V1.0 version. Results: From 1998 until 2001 the cost weights of medical procedures such as spine fusion operations and joint arthroplasty revision operations on the hip and on the knee with severe complications and co-morbidities increased continuously. This development was not seen in DRG's without complications and co-morbidities, in food and ankle procedures and in shoulder procedures. The average length of hospital stay decreased continuously with very few exceptions. The average length of stay for so called C-DRG's (109, 112, 113, 168, 169, 171, 175, 176) and in particular so called Z-DRG's (116-127) are in general longer by a factor of at least 2 in German hospitals when compared to Australian hospitals. Conclusion: A high quality of right-coding of ICD and ICPM Codes is a prerequisite to reach the correct revenue-relevant DRG. In Germany the average length of hospital stay is significantly longer than in Australia. In general the MDC-8-DRG's have demonstrated a smaller range when compared with the first calculated German DRG's in respect to the complexity of the procedures. Future management of the expected reductions in hospital stay will be based on a continouus co-operative efforts to improve the structural-, process- and (clinical guidelines and clinical pathways) and outcome quality of our medical procedures. The central objective of this effort is the well-being of our patients.