PMID- 22495963
OWN - NLM
STAT- MEDLINE
DCOM- 20120910
LR  - 20120412
IS  - 1439-3980 (Electronic)
IS  - 0722-1819 (Linking)
VI  - 44
IP  - 2
DP  - 2012 Apr
TI  - [Development of DRGs in reconstructive breast surgery].
PG  - 112-7
LID - 10.1055/s-0032-1306362 [doi]
AB  - Diagnosis-Related Groups (DRG) were introduced in Germany in 2004 as a 
      medico-economic classification system. In this analysis, we looked at 
      reconstructive surgery after breast cancer, focusing on changes of the 
      fee-per-case system in the last 6 years. Immediate, delayed, pedicle and free 
      flaps as well as alloplastic reconstructive methods were analysed using data from 
      German reference hospitals. We analysed the length of stay, reimbursements, costs 
      and profits. The biggest profit margin was found in free perforator flaps. These 
      were up to 3 times higher than in alloplastic reconstruction and pedicle flaps. 
      Due to the fact that the underlying costs for the calculation of reimbursement 
      are always retrospective, we accounted for the rate of price increase. In spite 
      of increasing mean profits, foregone profits of up to euro574 per case due to 
      inflation were not taken into consideration. Contrary to actual guidelines, 
      neither the immediate reconstruction of the breast by autologous tissue, nor the 
      bilateral reconstruction is taken into account economically. Although a more 
      differentiated reimbursement of breast reconstruction by DRG has taken place in 
      the last years, the subject still remains a classical example for insufficient 
      mapping of new medical standards in our DRG system. As the choice of surgical 
      therapy is increasingly influenced by free market mechanisms, the risk for 
      economic selection in contradiction to clinical recommendations becomes a real 
      problem. Even 9 years after its introduction, the German DRG system is far from 
      being a learning or quick adapting system.
CI  - (c) Georg Thieme Verlag KG Stuttgart . New York.
FAU - Lotter, O
AU  - Lotter O
AD  - Klinik fur Hand-, Plastische Rekonstruktive und Verbrennungschirurgie an der 
      Eberhard-Karls-Universitat Tubingen, Berufsgenossenschaftliche Unfallklinik. 
      oliver.lotter@freenet.de
FAU - Amr, A
AU  - Amr A
FAU - Jaminet, P
AU  - Jaminet P
FAU - Hoefert, S
AU  - Hoefert S
FAU - Schaller, H-E
AU  - Schaller HE
FAU - Stahl, S
AU  - Stahl S
LA  - ger
PT  - English Abstract
PT  - Journal Article
TT  - Fallpauschalenentwicklung in der rekonstruktiven Mammachirurgie.
DEP - 20120411
PL  - Germany
TA  - Handchir Mikrochir Plast Chir
JT  - Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen 
      Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen 
      Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ 
      der V...
JID - 8302815
SB  - IM
MH  - Cost Savings
MH  - Diagnosis-Related Groups/*economics
MH  - Female
MH  - Germany
MH  - Hospital Costs/statistics & numerical data
MH  - Humans
MH  - Length of Stay/economics
MH  - Mammaplasty/*economics
MH  - National Health Programs/*economics
MH  - Quality Assurance, Health Care/economics
MH  - Reimbursement Mechanisms/*economics
EDAT- 2012/04/13 06:00
MHDA- 2012/09/11 06:00
CRDT- 2012/04/13 06:00
PHST- 2012/04/13 06:00 [entrez]
PHST- 2012/04/13 06:00 [pubmed]
PHST- 2012/09/11 06:00 [medline]
AID - 10.1055/s-0032-1306362 [doi]
PST - ppublish
SO  - Handchir Mikrochir Plast Chir. 2012 Apr;44(2):112-7. doi: 10.1055/s-0032-1306362. 
      Epub 2012 Apr 11.