Drg

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

Diagnosis-related case groups; Diagnosis Related Groups

Definition
This section has been translated automatically.

Acronym for Diagnosis Related Groups. DRG refers to an economic-medical classification system in which patients are classified into case groups on the basis of their diagnoses and the treatments they have undergone. These groups are subdivided and evaluated according to the economic effort required for the treatment. Originally developed to measure performance and quality, the system was first used in 1983 for reimbursement in the US Medicare program. In Australia, the first version was released in 1992.

General information
This section has been translated automatically.

The case groups (DRGs) are valuated with a cost weight (cw = cost weight) that reflects the different treatment costs of the respective case group. Decisive criteria for assigning a treatment case to a diagnosis-related case group are the main diagnosis, the procedures performed in the hospital (operations, extensive examinations), secondary diagnoses and complications that have a significant influence on the course of treatment (in that increased diagnostic or therapeutic or nursing effort or monitoring effort must be credited to them), sex, age, weight and ventilation hours.
Diagnoses and procedures must be coded according to the German version of the "International Classification of Diagnoses and Diseases" (ICD-10 GM [German Modification]) and the Operation Code (OPS). The application of the OPS is bindingly regulated in §301 SGB V. The OPS includes operations, diagnostic measures, procedures, complex treatments and additional charges. The algorithm for determining a DRG from these data is published annually in the Definition Manual of the German Institute for Medical Documentation and Information (DIMDI) and is made available with certified grouper software for computer use. The International Classification of Procedures in Medicine (ICPM) was the basis for the development of the German OPS, but because of §301 SGB V it may not be used in Germany.
An adaptation to the German treatment reality is to be achieved by revision in annual intervals. The Institute for the Remuneration System in Hospitals in Siegburg ( InEK), founded in May 2001, is responsible for DRG calculation. The InEK also operates a proposal procedure in which new treatment procedures can be proposed for inclusion in the DRG system. A proposal submitted there results in either a rejection of the procedure, inclusion in the OPS directory and/or the introduction of a DRG.
Due to the "self-learning properties" of the DRG system, the InEK's annual DRG calculations are approximately 2-3 years behind schedule. The basis for a current year's calculation is therefore the data situation 2-3 years ago. In general, new DRGs are always added to the flat rate per case ordinance each year (e.g. to reflect the expense of new treatment modalities; the number of DRGs has been increasing for years), DRGs that are no longer relevant are removed. If necessary, existing DRGs are subjected to a case splitting (= refinement) that represents more effort within a basic DRG with a higher-priced split and represents less effort with a lower-priced split. To find out which splits of a base DRG are available, see the Flat Rate Ordinance. To find out which prerequisites the individual splits are based on, see the DRG Definition Manuals
Within the DRG system, the ICD catalogue and OPS are currently published annually by the German Institute for Medical Documentation and Information (DIMDI). The basis is the development of the billing data of the service providers over the last 3 years, which are transmitted to the InEK using sample data of service providers of different sizes and cost structures (university hospitals and non-university hospitals). Data from 225 costing hospitals with a total of 2.8 million data records were used to calculate the DRGs for 2007.
Participation in the calculation with transmission of service and cost data to the InEK is voluntary. Every year, the InEK publishes the catalogue of billable DRGs in the Fallpauschalenverordnung (FPV) (Flat Rate Ordinance). In the FPV, a valuation ratio (cost weight, relative weight) is specified for each DRG valid for the year in question, which reflects the cost difference between the various DRGs.
The DRG calculation values include:

Valuation ratio: The valuation ratio (or relative weight) is the revenue equivalent that is determined individually for each DRG based on a cost calculation. The cost calculation is carried out by the Institute for the Hospital Remuneration System (InEK).
Casemix (CM): The casemix is the sum of the relative weights of all DRGs performed within a time unit.
Casemix index (CMI): The CMI is calculated by dividing the casemix by the number of cases.
Baserate (base case value): The baserate is calculated from the DRG budget divided by the casemix.
Notice!
The calculation of a uniform base case value for the country is a goal-oriented process, which is expected to come into force in 2009. This is the end of the convergence phase (adjustment phase) of the individual base case values that have been agreed with the cost units for each service provider.
Notice!
Whether the convergence phase ends on 31.12.08 is a health policy decision!