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  • Title: Congenital heart surgery: applicability of hospital reimbursement according to German diagnosis-related groups system in conformity with the Aristotle complexity score.
    Author: Sinzobahamvya N, Photiadis J, Arenz C, Kopp T, Blaschczok HC, Hraska V, Asfour B.
    Journal: Thorac Cardiovasc Surg; 2010 Sep; 58(6):328-32. PubMed ID: 20824583.
    Abstract:
    BACKGROUND: Scores of Aristotle comprehensive complexity (ACC) levels have been demonstrated to correlate with the case-mix index (CMI) (cost-weights) generated by the German Diagnosis-Related Groups (DRG) 2009 version (G-DRG 2009). The equation used was "y = 0.5591 + 0.939 x" whereby y stands for cost-weight and x for ACC score. We hypothesised that each ACC level could be assigned a DRG (ACC DRG) and be used to determine hospital reimbursement. METHODS: 185 patients underwent cardiac surgery between January and June 2009. The ACC scores of these 185 patients were grouped in ACC levels, based on the basic cost-weight value of their DRG. One ACC DRG was assigned to each group and a corresponding cost-weight calculated based on the aforementioned equation. The resulting ACC CMI was compared with the CMI generated by the G-DRG 2009 (G-DRG 2009 CMI). Finally, the ACC surgical performance (complexity x hospital survival) was used to calculate the cost-weight; the obtained CMI was called "effective ACC CMI". RESULTS: Mean ACC score was 9.515 +/- 3.611 points. Derived ACC CMI and related G-DRG 2009 CMI were 9.494 and 8.438, respectively. Hospital survival was 97.8 % (181/184). Therefore ACC surgical performance and "effective ACC CMI" were 9.306 and 9.297, respectively. For each ACC level, the number of patients (n), mean ACC score, ACC CMI and related G-DRG 2009 CMI were as follows: Level 1: n = 25, 4.024 +/- 0.879, 4.338 and 5.911; Level 2: n = 30, 6.563 +/- 0.574, 6.722 and 6.602; Level 3: n = 43, 8.665 +/- 0.540, 8.695 and 8.088; Level 4: n = 73, 11.730 +/- 1.690, 11.574 and 9.612; Level 5: n = 14, 16.710 +/- 1.380, 16.249 and 11.843, respectively. CONCLUSIONS: The Aristotle score can be used to adjust hospital reimbursement by assigning a DRG and cost-weight value to each ACC level. Missing figures for level 6 can be obtained from a previous study which showed a mean score of 22.11 +/- 1.24: the ACC CMI would be 21.320. The 6 ACC DRGs indicate the correct compensation based on the complexity of the procedure. Reimbursement using the German DRG 2009 appears to favour less complex cases, while procedures with a higher complexity are penalised. Reimbursement according to "effective ACC CMIs" would have a strong impact by supporting units providing high-quality care.
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