PMID- 20824583
OWN - NLM
STAT- MEDLINE
DCOM- 20101228
LR  - 20100908
IS  - 1439-1902 (Electronic)
IS  - 0171-6425 (Linking)
VI  - 58
IP  - 6
DP  - 2010 Sep
TI  - Congenital heart surgery: applicability of hospital reimbursement according to 
      German diagnosis-related groups system in conformity with the Aristotle 
      complexity score.
PG  - 328-32
LID - 10.1055/s-0030-1249865 [doi]
AB  - 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.
CI  - Georg Thieme Verlag KG Stuttgart, New York.
FAU - Sinzobahamvya, N
AU  - Sinzobahamvya N
AD  - Congenital Cardiac Centre, Deutsches Kinderherzzentrum, Sankt Augustin, Germany. 
      n.sinzobahamvya@asklepios.com
FAU - Photiadis, J
AU  - Photiadis J
FAU - Arenz, C
AU  - Arenz C
FAU - Kopp, T
AU  - Kopp T
FAU - Blaschczok, H C
AU  - Blaschczok HC
FAU - Hraska, V
AU  - Hraska V
FAU - Asfour, B
AU  - Asfour B
LA  - eng
PT  - Journal Article
DEP - 20100907
PL  - Germany
TA  - Thorac Cardiovasc Surg
JT  - The Thoracic and cardiovascular surgeon
JID - 7903387
SB  - IM
CIN - Thorac Cardiovasc Surg. 2010 Sep;58(6):333. PMID: 20824584
MH  - Cardiac Surgical Procedures/adverse effects/*economics/mortality
MH  - Germany
MH  - Heart Defects, Congenital/*economics/mortality/*surgery
MH  - *Hospital Costs
MH  - Hospital Mortality
MH  - Humans
MH  - Infant
MH  - Infant, Newborn
MH  - Inpatients
MH  - Insurance, Health, Reimbursement/*economics
MH  - Length of Stay/economics
MH  - Models, Economic
MH  - Respiration, Artificial/economics
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2010/09/09 06:00
MHDA- 2010/12/29 06:00
CRDT- 2010/09/09 06:00
PHST- 2010/09/09 06:00 [entrez]
PHST- 2010/09/09 06:00 [pubmed]
PHST- 2010/12/29 06:00 [medline]
AID - 10.1055/s-0030-1249865 [doi]
PST - ppublish
SO  - Thorac Cardiovasc Surg. 2010 Sep;58(6):328-32. doi: 10.1055/s-0030-1249865. Epub 
      2010 Sep 7.