10 years of the DRG system: experts take stock

Berlin - The DRG system was introduced in Germany ten years ago. At the 21st management seminar of the Association of Hospital Directors of Germany (VKD) and the Association of the Diagnostics Industry (VDGH) in Berlin yesterday and the day before yesterday, experts discussed how the diagnosis-oriented flat-rate flat rates have changed the German health system. "Non-DRG-relevant areas were dismantled - according to the motto: I don't need anything that I can't bill, or I try to keep it as lean as possible," said the commercial director of the Aachen University Hospital, Peter Asché.

Over the past ten years, the number of doctors at German hospitals has increased steadily: from 114,000 full-time positions in 2003 to 139,000 in 2011. “This increase is due to the DRG system, because the staff is important that can generate billable services, ”said Asché. In contrast, the number of nursing staff fell from 320,000 full-time positions in 2003 to 298,000 positions in 2007, before increasing again to 310,000 positions by 2011. The reason for the renewed increase was the increasing workload in the hospital.

The number of administrative staff also increased between 2003 and 2011: from 58,000 to almost 60,000 full-time positions. The reason for this was the new professional groups that arose in connection with the DRG system, for example coding specialists, explained Asché. So here money flowed from the area of ​​patient care into the administration area.

The administration has grown considerably due to the documentation and coding requirements, said the medical director and chairman of the board of the university hospital Munster, Norbert Roeder. Primary documentation and coding, billing preparations and plausibility checks have become very complex and withdraw money from patient care. "We have reduced our attention to the patient," said Roeder. Because it is not financed.

Overall, Roeder's conclusion of the flat-rate system was rather positive: “Most of the costs incurred can be paid over the DRG system will be financed. The incentives have increased the efficiency of the system. And we experienced intense cost competition. ”The DRG system did not deteriorate the quality of inpatient care - at least it remained at the same level. But today the services provided could be presented more transparently.

The DRG system is often accused of providing incentives for increased volume development, Roeder continued. However, there are various factors for this development: “People are getting older and want to be pain-free even in old age. For that they need new joints. "If the politicians want this differently, they have to put stop to these wishes as in countries with waiting times.

" The supply rate for hip and knee replacements in Germany is compared to other countries high, ”said Fritz Uwe Niethard, General Secretary of. A high supply rate is also an expression of highly developed health system.

The German Medical Association recently took stock of the DRG system. Their conclusion: "The DRG case flat rate system is overwhelmed in its previous role as price-quantity system that is decisive for the economic development of hospitals." As direct price system, the case flat rates would become the almost exclusive determining factor for the economic survival of hospitals >

The inability of the system to react to current cost developments in the area of ​​tariffs or energy costs is particularly problematic. The BÄK therefore calls for the DRG revenue budget to be used in future only as lower limit for determining and future billing of the hospital revenue volume.

In addition, sufficient discretion should be created for regional agreements on remuneration, in particular for securing hospital treatment close to home in structurally weak regions, the financing of extreme cost cases and transplant medicine, the special promotion of quality, hygiene and training or the immediate response to tariff adjustments, adjustments to liability insurance or energy surcharges.