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Ist ein Polytrauma heutzutage noch bezahlbar?

G-DRG-System vs. Tagessätze anhand 1030 polytraumatisierter Patienten

Is polytrauma affordable these days?

G-DRG system vs per diem charge based on 1,030 patients with multiple injuries

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Zusammenfassung

Hintergrund

Die Umstellung auf ein auf Hauptdiagnosen beruhendes pauschales Vergütungssystem birgt in komplexen medizinischen Bereichen das Risiko einer nicht realitätstreuen Kostenerstattung.

Material und Methoden

Insgesamt wurden 1030 polytraumatisierte (ISS≥16) Patienten mit einem mittleren „Injury Severity Score“ (ISS) von 26,4 aus den Jahren 2000–2004 erfasst. Es erfolgte ein Vergleich zwischen den beiden Abrechnungssystemen nach Tagessätzen und nach dem G-DRG-System Version 2004 mit einer „base rate“ von 2900 EUR.

Ergebnisse

Es zeigt sich, dass nur ca. die Hälfte aller Patienten entsprechend ihrer Verletzungsschwere im DRG-System einer polytrauma- (18,7%) bzw. beatmungsgetriggerten DRG (29,1%) zugeordnet werden. Der mittlere Erlös lag nach dem Tagessatzmodell bei 36.387 vs. 27.157 EUR nach dem DRG-System (74,6%). Besonders groß war diese Diskrepanz u. a. bei geringer Verletzungsschwere, zunehmendem Alter, hohem „Glasgow Coma Scale“ (GCS), Intensivaufenthalt ohne maschineller Beatmung, Verletzung insbesondere der oberen Extremität und bei den überlebenden Patienten.

Schlussfolgerung

Weitere notwendige Veränderungen der G-DRG-Gewichtungen sind notwendig, um eine gerechte Vergütung für die Behandlung polytraumatisierter Patienten zu gewährleisten. Ebenso sollte die Schwere der Verletzung im DRG-System widergespiegelt werden.

Abstract

Abstract

The introduction of diagnosis-related groups (DRG) in Germany comprises the risk of a non-cost-effective reimbursement in complex medical treatments. The aim of this study was to compare the reimbursement between the DRG system and the system of hospital per diem charge in effect until now.

Material and methods

The G-DRG (Version 2004) reimbursement was calculated for 1,030 polytrauma patients (average ISS 26.4) treated at the BGU Murnau from 2000 to 2004, using a base value of 2900 euros, and compared to the reimbursement of hospital per diem charge.

Results

Just half of all polytrauma patients are classified as a polytrauma according to the DRG (18.7%) or as requiring artificial respiration based on the DRG (29.1%). The average G-DRG reimbursement was 27,157 euros vs 36,387 euros (74.6%). Patients with minor trauma, increasing age, high GCS, ICU stay without artificial respiration, trauma of the upper extremity and patients who survived show the greatest discrepancy.

Conclusion

A revision of the G-DRG definition of polytrauma is necessary to ensure adequate reimbursement for management of patients with multiple injuries. The severity of a trauma has to be considered in the DRG system.

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Authors and Affiliations

  1. Klinikum Garmisch-Partenkirchen, Auenstraße 6, 82467, Garmisch-Partenkirchen, Deutschland

    B. Qvick

  2. Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland

    V. Buehren & A. Woltmann

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  1. B. Qvick
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  2. V. Buehren
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  3. A. Woltmann
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Correspondence to B. Qvick.

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Qvick, B., Buehren, V. & Woltmann, A. Ist ein Polytrauma heutzutage noch bezahlbar?. Unfallchirurg 115, 892–896 (2012). https://doi.org/10.1007/s00113-010-1920-7

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  • DOI: https://doi.org/10.1007/s00113-010-1920-7

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