[Reimbursement of patients with high costs in a department of otorhinolaryngology of maximum care and refinancing by the German DRG system].
BACKGROUND
With the introduction of a diagnosis related groups (DRG)-system in Germany, the medical analysis of the total costs of caring for a given patient is of significance. The medical identification of cost intensive patients becomes of increasing importance for the financial perspective of a department, because the averaged lump sum system might not break even these treatments.


METHODS
In the Department of Otorhinolaryngology, University Ulm, a tertiary referral center, the 56 most expensive patients from 3131 inpatients which were treated in 2002 were retrospectively identified and expenses for diagnostic tests, therapy and post-operative complications were analyzed. All patients' related costs, including all costs for personnel, were assigned to a DRG (Version 1.0 G-DRG and G-DRG 2004).


RESULTS
The most expensive treatments included extensive tumor surgeries, surgery of the trachea, emergency procedures and reconstructive surgery. Costs increased with complications, prolonged stay in the intensive care unit and simultaneous internal diseases. The cost at our institution for an pharynocutaneous fistula added 3000 Euro.


CONCLUSIONS
The assignment of treatment costs to a DRG is complex. Based on our data extensive surgeries for head and neck malignancies showed a homogeneous cost distribution in the DRG group of G-DRG 2004 which was however inadequately reimbursed. Detailed prospective analyses from multiple centers to identify expensive treatments in the field of otorhinolaryngology are necessary to incorporate modifications into the German DRG-system.
Bachor
E
E
Universitäts-Hals-Nasen-Ohren-Klink, Ulm. ebmail@web.de
Neun
O
O
Bogeschdorfer
F
F
Gruen
P M
PM
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups / Q000191:economics*; D003955:Diagnostic Tests, Routine / Q000191:economics; D005260:Female; D005858:Germany; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007362:Intensive Care Units / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010038:Otorhinolaryngologic Diseases / Q000191:economics* / Q000601:surgery / Q000628:therapy; D013517:Otorhinolaryngologic Surgical Procedures / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors