Ten years after the introduction of the DRG system, experts take stock: The system has become more efficient. However, due to the reduction in nursing staff, the attention to patients has been reduced. And: The system has reached its limits.
With the introduction of the DRG system, the financing of the inpatient sector was fundamentally redesigned. The aim of the reform was primarily to reduce costs, but also to achieve more transparency and create new incentives. It should no longer be financially worthwhile to keep patients in the house for as long as possible. After ten years, it is now time to take stock. How has the DRG system changed the inpatient sector?
Administration increased
" Areas that are not relevant to DRG have been 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, ”summarized the commercial director of the Aachen University Hospital, Peter Asché, at the end of February the 21st management seminar of the Association of Hospital Directors in Germany and the Association of the Diagnostics Industry.
A direct consequence of the system change is that the number of doctors at German hospitals has steadily increased: from 114 105 full-time positions per year 2003 to 138 955 in 2011. Because what is important is the staff who can generate billable services. In contrast, the number of nurses fell from 320 158 full-time positions in 2003 to 298 325 positions in 2007, before increasing again to 310 817 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, explained Asché: from 57,927 to 59,759 full-time positions. Because with the DRG system, new professional groups such as coding specialists have emerged.
The administration has grown considerably due to the documentation and coding obligation, said the Medical Director and Chairman of the Board of Management of the Münster University Hospital, Prof. Dr. med. 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 patients," said Roeder. Because it is not financed.
Ten years after the introduction of the DRG system, experts take stock: The system has become more efficient. However, due to the reduction in nursing staff, the attention to patients has been reduced. And: The system has reached its limits.
With the introduction of the DRG system, the financing of the inpatient sector was fundamentally redesigned. The aim of the reform was primarily to reduce costs, but also to achieve more transparency and create new incentives. It should no longer be financially worthwhile to keep patients in the house for as long as possible. After ten years, it is now time to take stock. How has the DRG system changed the inpatient sector?
Administration increased
" Areas that are not relevant to DRG have been 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, ”summarized the commercial director of the Aachen University Hospital, Peter Asché, at the end of February the 21st management seminar of the Association of Hospital Directors in Germany and the Association of the Diagnostics Industry.
A direct consequence of the system change is that the number of doctors at German hospitals has steadily increased: from 114 105 full-time positions per year 2003 to 138 955 in 2011. Because what is important is the staff who can generate billable services. In contrast, the number of nurses fell from 320 158 full-time positions in 2003 to 298 325 positions in 2007, before increasing again to 310 817 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, explained Asché: from 57,927 to 59,759 full-time positions. Because with the DRG system, new professional groups such as coding specialists have emerged.
The administration has grown considerably due to the documentation and coding obligation, said the Medical Director and Chairman of the Board of Management of the Münster University Hospital, Prof. Dr. med. 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 patients," said Roeder. Because it is not financed.
Overall, however, Roeder's conclusion of the flat rate system was rather positive: “The majority of the costs incurred can be financed through the flat rate case. The incentives have increased the efficiency of the system. And we have 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.
BÄK: Converting the DRG system
After the introduction of the flat rate per case, hospitals have implemented savings over the years through rationalization. However, many houses have now reached the limit of what is feasible and have slipped into the red. This increases the risk that the necessary inpatient care cannot be maintained everywhere. The German Medical Association (BÄK) therefore advocates changing the DRG system. The BÄK writes in position paper (DÄ, Issue 7/2014).
The problem is particularly the inability to cope with the situation, “in its previous role as price-quantity system that is decisive for the economic development of hospitals” the system to react to current cost developments in the area of tariffs or energy costs. 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 to ensure hospital treatment close to home in structurally weak regions, the financing of extreme cost cases or the immediate reaction to adjustments to tariffs or liability insurance.
Falk Osterloh
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