Does the Current DRG System Reflect the Reality of Operative Endometriosis Therapy?

Schafer SD, Bruning K, Fiori W, Kiesel L, Buchweitz O

Abstract

Purpose: In-patient services and hospital costs can only be correctly reimbursed if they are properly represented in the DRG system through differentiation using ICD and OPS. In 2008 this still appears to pose a problem for the various forms of endometriosis and their therapies. Method: A retrospective analysis of all in-patient endometriosis operations performed in the Gynaecology Department, University Hospital Munster in 2006 and 2007 was performed, and the ICD and OPS codes, DRG, operating time (OT), length of hospitalisation (LOH), costs and reimbursement were examined. Data for deeply infiltrating (DE) and for superficial endometriosis (SE) were compared (Student's t-test, p < 0.05). Results: Most frequently, cases were grouped to DRGs N07Z (27.1%), N21Z (20.9%) and N25Z (7.3%). However, OT (120.39 +/- 8.08 vs. 79.30 +/- 7.17 min) and LOH (3.66 +/- 0.334 vs. 2.77 +/- 0.31 days) were significantly longer for DE. N07Z-DE cases incurred significantly higher costs (+ 559 Euro) than N07Z-SE cases while reimbursement did not differ significantly. Bowel resection for bowel endometriosis is grouped to N34Z. This DRG has a much higher reimbursement (3.98 case mix points) than bowel-sparing therapy (1.68). Conclusion: DE prolongs OT and LOH and leads to higher costs within the different DRGs. As sub-specialisation leads to a disproportionate distribution of SE and DE cases between hospitals, it will be necessary to adjust to this situation. As a first step the possibility of differentiated coding has to be created. The fact that: bowel resection is more highly reimbursed than bowel-sparing techniques could lead to an economic selection in favour of bowel resection, although at present no clear medical advantage of resection has been identified.