[Development of length of stay and reimbursement in elective hand surgery after the introduction of DRGs in Germany].

Background: Since its introduction in Germany, the DRG (Diagnosis-Related Groups) system is often fraught with negative connotations. Frequent points of criticism are a deterioration of patient care by decreasing length of stay (LOS) in hospital and a decline in reimbursement. The following investigation analyzes and compares the development of length of stay and reimbursement in hand surgery based on the 3 most common elective procedures.

Material And Methods: The main diagnoses scaphoid nonunion (PSA), Dupuytren's contracture (DK) and rhizarthrosis (RIA) were evaluated for number of cases, length of stay, reimbursement per day and total reimbursement in 2000 as well as 2010 based on the data of our clinic. Patients covered by the Employers' Liability Insurance were not included. Only inpatient cases were considered.

Results: In PSA and RIA an increase in the number of cases is reported (PSA: +11 cases; RIA: +26 cases) and a decrease in DK ( - 7 cases). The sum of the total hospital days declined despite rising case numbers predominantly between 65 (RIA) and 260 days (DK). The average LOS decreased by 3.1 days at DK (48.4%) to 4.1 days at PSA (52.6%). Average revenues per day in 2000 amounted to 379 €, which corresponds to 442 € adjusted for inflation in 2010. Average revenue per day in 2010 was 755 € (RIA), 797 € (PSA) and 876 € (DK). Revenue per case in 2010 were only higher than in 2000, when 5 (RIA) or 6 hospital days (DK and PSA) were not exceeded.

Conclusion: With declining revenue per case, the average income per day increased by a reduction in hospital days. A positive or at least equivalent revenue situation can thus only be achieved by a distinct concentration of labor and reduction of hospital days under the DRG-system.