ABC of DRGs – the European Experience.ppt

England France Germany Netherlands Cost data collection methodology to determine payment rate Sample size(% of all hospitals) All NHS hospitals 99 hospitals (5%) 253 hospitals (13%) Resource use: all hospitals; unit costs: 15-25 hospitals (24%) Cost accounting methodology Top down Mix of top-down and bottom-up Mainly bottom-up Mainly bottom-up Calculation of hospital payment Payment calculation Direct (price) Indirect (cost-weight) Indirect (cost-weight) Direct (price) Applicability Nationwide (but adjusted for market-forces-factor) Nationwide (with adjustments and separate for public and private hospitals) Cost-weights nationwide; monetary conversion state-wide List A: nationwide List B: hospital specific Volume/ expenditure limits No (plans exist for volume cap) Yes Yes List A: Yes List B: Yes/No Cost calculation and price setting – country experience Price setting Cost weights Base rate(s) Prices/ tarifs Average vs. “best” Being aware of strategic behaviour of hospitals in times of DRGs Options to avoid deficits under activity based payments LOS Revenues Costs/ Total costs DRG-type payment Reduce LOS Increase revenues (right-/ up-coding; negotiate extra payments) Reduce costs (personnel, cheaper technologies) How DRG systems try to counter-act such behaviour:1. long- and short-stay adjustments LOS Revenues Deductions(per day) Surcharges(per day) Short-stay outliers Long-stay outliers Inliers Lower LOSthreshold Upper LOSthreshold Actual reimbursement Volume limits Outliers High cost cases Negotiations How DRG systems try to counter-act such behaviour:2. FFS-type additional payments Actual reimbursement Volume limits Outliers High cost cases Negotiations England France Germany Nether-lands Payments per hospital stay One One One Several possible Payments for specific high-cost services Unbundled HRGs for e.g.: Chemotherapy Radiotherapy Renal dialysis Diagnostic imaging High-cost drugs Séances GHM for e.g.: Chemotherapy Radiothe