title: Reimbursement of care for severe trauma under SwissDRG.
abstract: OBJECTIVE
  Treatment of patients with severe injuries is costly, with best results achieved in specialised care centres. However, diagnosis-related group (DRG)-based prospective payment systems have difficulties in depicting treatment costs for specialised care. We analysed reimbursement of care for severe trauma in the first 3 years after the introduction of the Swiss DRG reimbursement system (2012-2014).
  
  
  METHODS
  The study included all patients with solely basic insurance, hospital admission after 01.01.2011 and discharge in 2011 or 2012, who were admitted to the resuscitation room of the University Hospital of Zurich, aged ≥16 years and with an injury severity score (ISS) ≥16 (n = 364). Clinical, financial and administrative data were extracted from the electronic medical records. All cases were grouped into DRGs according to different SwissDRG versions. We considered results to be significant if p ≤0.002.
  
  
  RESULTS
  The mean deficit decreased from 12 065 CHF under SwissDRG 1.0 (2012) to 2 902 CHF under SwissDRG 3.0 (2014). The main reason for the reduction of average deficits was a refinement of the DRG algorithm with a regrouping of 23 cases with an ISS ≥16 from MDC 01 to DRGs within MDC21A. Predictors of an increased total loss per case could be identified: for example, high total number of surgical interventions, surgeries on multiple anatomical regions or operations on the pelvis (p ≤0.002). Psychiatric diagnoses in general were also significant predictors of deficit per case (p<0.001).
  
  
  CONCLUSIONS
  The reimbursement for care of severely injured patients needs further improvement. Cost neutral treatment was not possible under the first three versions of SwissDRG.
authors.affiliation: Medical Directorate, University Hospital of Zurich, Switzerland.
authors.forename: Rudolf M
authors.initials: RM
authors.lastname: Moos
authors.affiliation: Division of Trauma Surgery, University Hospital of Zurich, Switzerland.
authors.forename: Kai
authors.initials: K
authors.lastname: Sprengel
authors.affiliation: Division of Trauma Surgery, University Hospital of Zurich, Switzerland.
authors.forename: Kai Oliver
authors.initials: KO
authors.lastname: Jensen
authors.affiliation: Division of Trauma Surgery, University Hospital of Zurich, Switzerland.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Jentzsch
authors.affiliation: Division of Trauma Surgery, University Hospital of Zurich, Switzerland.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Simmen
authors.affiliation: Biostatistics Department, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Division of Trauma Surgery, University Hospital of Zurich, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Ciritsis
authors.affiliation: Division of Trauma Surgery, University Hospital of Zurich, Switzerland.
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.affiliation: Medical Directorate, University Hospital of Zurich, Switzerland.
authors.forename: Jörk
authors.initials: J
authors.lastname: Volbracht
authors.affiliation: Medical Directorate, University Hospital of Zurich, Switzerland.
authors.forename: Tarun
authors.initials: T
authors.lastname: Mehra
mesh_terms: D000328:Adult; D000368:Aged; D003953:Diagnosis-Related Groups / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D015601:Injury Severity Score; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D013557:Switzerland; D014947:Wounds and Injuries / Q000191:economics* / Q000628:therapy; D055815:Young Adult