title: Minimally invasive, minimally reimbursed? Anesthesia for endoscopic cardiac surgery is not reflected adequately in the german diagnosis-related group system.
abstract: OBJECTIVE
  In the German diagnosis-related group (G-DRG) system, hospital reimbursement for anesthesia is linked to specific surgical procedures, irrespective of case duration. Accordingly, costs of innovative procedures, such as endoscopic cardiac surgery, may be underreimbursed. The authors assessed to what extent anesthesia costs for endoscopic cardiac surgery are reimbursed with the G-DRG system.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Eighty-four patients were studied undergoing general anesthesia for minimally invasive endoscopic port-access intracardiac surgery (n = 42) or conventional "open" surgery (n = 42) for similar indications.
  
  
  METHODS
  None.
  
  
  RESULTS
  The authors measured anesthesia staffing time, costs, and reimbursement for endoscopic cardiac surgery and compared results with data from a matched group undergoing conventional surgery. Endoscopic surgery increased anesthesia staffing time per case by 521 minutes (977 minutes +/- 177 v 456 +/- 92, mean +/- standard deviation, p = 0.0001) and costs by approximately 200%. Anesthesia duration increased by 152 minutes (503 minutes +/- 89 v 351 +/- 69, p = 0.0001). In contrast, staffing reimbursement did not increase at the time of the patient's surgery (euro500/case [446-569] v 492 [452-508], p = 0.75, median [interquartile range]) or with the 2007 G-DRG matrix (euro548/case [463-559] v 503 [503-568], p = 0.48). Cost recovery was only 66% +/- 17.4% and 72.7 +/- 38.9 in the 2007 G-DRG matrix, respectively.
  
  
  CONCLUSIONS
  It was shown that (1) endoscopic cardiac surgery consumed more anesthesia resources and was underreimbursed both relative to actual costs and to conventional surgery, (2) costs for such anesthesia services were inappropriately reflected in the G-DRG system, and (3) a DRG system's inability to adapt timely to innovative procedures may adversely affect anesthesia departments and medical progress.
authors.affiliation: Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Universitätsklinikum Essen, Essen, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Kottenberg-Assenmacher
authors.forename: Peter
authors.initials: P
authors.lastname: Merguet
authors.forename: Markus
authors.initials: M
authors.lastname: Kamler
authors.forename: Jürgen
authors.initials: J
authors.lastname: Peters
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000191:economics*; D000768:Anesthesia, General / Q000191:economics; D006348:Cardiac Surgical Procedures / Q000191:economics*; D002315:Cardiopulmonary Bypass / Q000191:economics; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D005260:Female; D005858:Germany; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D010561:Personnel Staffing and Scheduling / Q000191:economics; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies