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Knee replacement and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries

Abstract

Purpose

Researchers from 11 countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their Diagnosis-Related Group (DRG) systems deal with knee replacement cases. The study aims to assist knee surgeons and national authorities to optimize the grouping algorithm of their DRG systems.

Methods

National or regional databases were used to identify hospital cases treated with a procedure of knee replacement. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97 % of cases. Five standardized case scenarios were defined and quasi-prices according to national DRG-based hospital payment systems ascertained.

Results

Grouping algorithms for knee replacement vary widely across countries: they classify cases according to different variables (between one and five classification variables) into diverging numbers of DRGs (between one and five DRGs). Even the most expensive DRGs generally have a cost index below 2.00, implying that grouping algorithms do not adequately account for cases that are more than twice as costly as the index DRG. Quasi-prices for the most complex case vary between €4,920 in Estonia and €14,081 in Spain.

Conclusions

Most European DRG systems were observed to insufficiently consider the most important determinants of resource consumption. Several countries’ DRG system might be improved through the introduction of classification variables for revision of knee replacement or for the presence of complications or comorbidities. Ultimately, this would contribute to assuring adequate performance comparisons and fair hospital reimbursement on the basis of DRGs.

Level of evidence

Retrospective comparative study, Level III.

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References

  1. Best JT (2005) Revision total hip and total knee arthroplasty. Orthop Nurs 24:174–179

    PubMed  Article  Google Scholar 

  2. Bozic KJ, Durbhakula S, Berry DJ, Naessens JM, Rappaport K, Cisternas M, Saleh KJ, Rubash HE (2005) Differences in patient and procedure characteristics and hospital resource use in primary and revision total joint arthroplasty: a multicenter study. J Arthroplasty 20:17–25

    PubMed  Article  Google Scholar 

  3. Busse R, Geissler A, Quentin W, Wiley MM (2011) Diagnosis-Related Groups in Europe: moving towards transparency, efficiency and quality in hospitals. Open University Press and WHO Regional Office for Europe, Buckingham, pp 1–458

    Google Scholar 

  4. Casemix Service (2008) HRG 4 design concepts. The Information Centre, National Health Service (NHS), Leeds, pp 1–42

  5. Cots F, Chiarello P, Salvador X, Castells X, EuroDRG group (2012) Patient classification systems and hospital costs of care for knee replacement in 10 European countries. Health Econ 21(Suppl 2):116–128

    PubMed  Article  Google Scholar 

  6. Cots F, Elvira D, Castells X, Dalmau E (2000) Medicare’s DRG-weights in a European environment: the Spanish experience. Health Policy 51:31–47

    PubMed  Article  CAS  Google Scholar 

  7. Effenberger H, Rehart S, Zumstein MD, Schuh A (2008) Financing in knee arthroplasty: a benchmarking analysis. Arch Orthop Trauna Surg 128:1349–1356

    Article  Google Scholar 

  8. InEK (2011) Vorschlagsverfahren zur Einbindung des medizinischen, wissenschaftlichen und weiteren Sachverstandes bei der Weiterentwicklung des G–DRG-Systems für das Jahr 2012. Institut für das Entgeldsystem im Krankenhaus (InEK), Siegburg, pp 1–9

  9. Kimberly JR, Gd Pouvourville, D’Aunno TA (2008) The globalization of managerial innovation in health care. Cambridge University Press, Cambridge, pp 1–394

    Book  Google Scholar 

  10. Prismant Kiwa (2008) Hospital data project phase 2: final report. The need for metadata and data. Kiwa Prismant, Utrecht, pp 1–54

    Google Scholar 

  11. Kobel C, Thuilliez J, Bellanger MM, Pfeiffer KP (2011) DRG systems and similar patient classification systems in Europe. In: Busse R, Geissler A, Quentin W, Wiley MM (eds) Diagnosis-Related Groups in Europe: moving towards transparency, efficiency and quality in hospitals, 1st edn. Open University Press and WHO Regional Office for Europe, Buckingham, pp 37–58

    Google Scholar 

  12. Koechlin F, Lorenzoni L, Schreyer P (2010) Comparing price levels of hospital services across countries: results of pilot study. OECD Health, Paris, pp 1–59

    Book  Google Scholar 

  13. OECD (2012) OECD Health data 2012. Organisation for Economic Co-operation and Development (OECD), Paris, http://www.oecd.org/health/healthpoliciesanddata/oecdhealthdata2012.htm

  14. Patris A, Blum D, Girardier M (2001) A change in the French patient classification system. CASEMIX Q 3(34):128–138

    Google Scholar 

  15. Quentin W, Scheller-Kreinsen D, Geissler A, Busse R, on behalf of the EuroDRG group (2012) Appendectomy and diagnosis-related groups (DRGs): patient classification and hospital reimbursement in 11 European countries. Langenbecks Arch Surg 397:317–326

    PubMed  Article  Google Scholar 

  16. Reid B, Sutch S (2008) Comparing diagnosis-related group systems to identify design improvements. Health Policy 87:82–91

    PubMed  Article  Google Scholar 

  17. Sanchez-Martinez F, Abellan-Perpinan JM, Martinez-Perez JE, Puig-Junoy J (2006) Cost accounting and public reimbursement schemes in Spanish hospitals. Health Care Manag Sci 9:225–232

    PubMed  Article  Google Scholar 

  18. Schreyogg J, Stargardt T, Tiemann O, Busse R (2006) Methods to determine reimbursement rates for diagnosis related groups (DRG): a comparison of nine European countries. Health Care Manag Sci 9:215–223

    PubMed  Article  Google Scholar 

  19. Soderlund N, Gray A, Milne R, Raftery J (1996) Case mix measurement in English hospitals: an evaluation of five methods for predicting resource use. J Health Serv Res Policy 1:10–19

    PubMed  CAS  Google Scholar 

  20. Street A, Scheller-Kreinsen D, Geissler A, Busse R (2010 May) Determinants of hospital costs and performance variation: methods, models and variables for the EuroDRG project. Working papers in health policy and management 3

  21. Tan SS, van Ineveld BM, Redekop WK, Hakkaart-van Roijen L (2010) Structural reforms and hospital payment in the Netherlands. EuroObserver 12:7–9

    Google Scholar 

  22. Wilson NA, Schneller ES, Montgomery K, Bozic KJ (2008) Hip and knee implants: current trends and policy considerations. Health Aff 27(6):1587–1598

    Article  Google Scholar 

Download references

Acknowledgments

The results presented in this paper were generated as part of the project ‘Diagnosis-Related Groups in Europe: Towards Efficiency and Quality (EuroDRG)’, which was funded by the European Commission within the Seventh Framework Research Programme (Grant Agreement Number FP7-223300). The authors are grateful to all our project partners who made this work possible. They particularly thank Reinhard Busse, Francesc Cots, Leona Hakkaart-van Roijen, Martin van Ineveld and Ken Redekop for their contribution to this study.

Conflict of interest

The authors have no conflicts of interest regarding the contents of this paper.

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Correspondence to Siok Swan Tan.

Additional information

This study was conducted on behalf of the EuroDRG group (http://www.eurodrg.eu/EuroDRG_Group.pdf).

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Tan, S.S., Chiarello, P. & Quentin, W. Knee replacement and Diagnosis-Related Groups (DRGs): patient classification and hospital reimbursement in 11 European countries. Knee Surg Sports Traumatol Arthrosc 21, 2548–2556 (2013). https://doi.org/10.1007/s00167-013-2374-6

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  • DOI: https://doi.org/10.1007/s00167-013-2374-6

Keywords

  • Knee arthrosis
  • Knee fracture
  • Knee replacement
  • Diagnosis-Related Groups
  • Europe
  • Economics