title: [Analysis of Diagnosis Related Groups and their Impact on Health Care in Post Massive Weight Loss Surgery].
abstract: BACKGROUND
  Diagnosis Related Groups (DRG) were introduced in Germany as a medico-economic classification system in 2004. In this analysis, we looked at restorative surgery after massive weight loss, focusing on reimbursement of this fee-per-case system in comparison to costs to deduce possible effects on health care over time.
  
  
  METHODS
  First we analysed the algorithms for the relevant DRGs including data about length of stay and reimbursement. Furthermore, we integrated cost data from German reference hospitals of the last 5 years as well as single-centre data from a university hospital.
  
  
  RESULTS
  Due to a diagnosis-related algorithm, coding will constantly lead to DRG K07Z. In 2016, a new diagnosis code specific to massive weight loss was introduced, which now leads to DRG J10B. As a result, reimbursement is reduced by more than half. In the cost matrix, staff, general ward, operation theatre and anaesthesia were identified as the main cost drivers. As expected, there was a statistically significant correlation between general ward costs and time of stay in hospital as well as operation theatre costs and incision-suture time. Considering the cost data of the reference hospitals, there was an average excess of EUR 781 per case whereas our own cost data revealed a deficit of EUR 1 700 to 2 700 per case. This is mainly due to the fact that approximately one third of our patient cohort underwent highly elaborate circular body lifts.
  
  
  CONCLUSIONS
  It has to be questioned whether a newly introduced main diagnosis code can be applied as such without any underlying cost data having been collected in previous years. Given unchanged treatment measures, the main cost drivers identified by us remain the same, which means that there is no rationale for a drop in revenue. In addition to providing incentives for an efficient use of resources and quality optimisation, this system should offer medical service providers a sustainable and realistic possibility to break even.
authors.affiliation: Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie, Klinikum Landkreis Tuttlingen.
authors.forename: O
authors.initials: O
authors.lastname: Lotter
authors.affiliation: Klinik für Mund-, Kiefer- und Gesichtschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen.
authors.forename: S
authors.initials: S
authors.lastname: Hoefert
authors.affiliation: Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen.
authors.forename: M
authors.initials: M
authors.lastname: Micheel
authors.affiliation: Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen.
authors.forename: P
authors.initials: P
authors.lastname: Gonser
authors.affiliation: Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen.
authors.forename: H-E
authors.initials: HE
authors.lastname: Schaller
authors.affiliation: Klinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie an der Eberhard-Karls-Universität, Berufsgenossenschaftliche Unfallklinik Tübingen.
authors.forename: J
authors.initials: J
authors.lastname: Rothenberger
mesh_terms: D050110:Bariatric Surgery; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D015431:Weight Loss