Lotter Oliver, Micheel Manuela, Jaminet Patrick
Klinikum Landkreis Tuttlingen, Klinik für Plastische, Ästhetische, Hand- und Wiederherstellungschirurgie.
Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Universitätsklinik für Plastische Chirurgie und Schwerbrandverletzte, Handchirurgiezentrum, Operatives Referenzzentrum für Gliedmaßentumore.
Handchir Mikrochir Plast Chir. 2018 Apr;50(2):126-133. doi: 10.1055/s-0043-111410. Epub 2017 Oct 26.
Diagnosis Related Groups (DRGs) were introduced in Germany as a medico-economic classification system 13 years ago. In this analysis, we looked into the compensation for reconstructive plastic surgery after the excision of malignant head and neck skin tumours by DRGs.
Four main diagnoses (malignant melanoma, basal cell carcinoma, squamous cell carcinoma, carcinoma in situ) at a maximum of 6 different locations in the head and neck were combined with the following procedures: excision and primary wound closure, excision with temporary soft tissue coverage, split-thickness or full-thickness skin grafting, local, free or regional pedicle flaps, distant flaps as well as combined procedures for coverage.
We defined 10 different DRGs based on 5750 combinations of diagnoses and procedures. DRG J22Z (revenue: EUR 2817) predominated for large temporary soft tissue coverage and skin grafting techniques. In 2017, local flaps were devaluated and now lead to DRG J11D (revenue: EUR 1903) in most cases. In this context, an aggregation of cases by a two-stage approach (stage 1: excision, stage 2: reconstruction) is particularly important. Malignant tumours of the lips are inconsistently represented by DRGs with a lack of definite rules. The highly rated main group DRG J08 (including DRGs J08A, J08B and J08C) can be achieved almost invariably by addition of specific single procedures.
The current representation of reconstructive surgery for malignant skin tumours by DRGs is associated with potential disincentive effects, which may have an impact on patient care. In search of a diversified portfolio, the main group DRG J08 should be considered in addition to the common practice of coding. The authors of this study think that this may be a possibility to compensate for the actual devaluation and to achieve resource-related reimbursement in high-cost cases. However, incorrect and inflationary use should be avoided due to the lack of long-term orientation caused by dilution of the DRGs.
13年前，诊断相关分组（DRGs）作为一种医疗经济分类系统被引入德国。在本分析中，我们研究了DRGs对恶性头颈部皮肤肿瘤切除术后整形重建手术的补偿情况。
将头颈部最多6个不同部位的四种主要诊断（恶性黑色素瘤、基底细胞癌、鳞状细胞癌、原位癌）与以下手术方式相结合：切除并一期伤口闭合、切除并临时软组织覆盖、断层或全厚皮片移植、局部、游离或区域带蒂皮瓣、远位皮瓣以及联合覆盖手术。
基于5750种诊断和手术方式的组合，我们定义了10种不同的DRGs。DRG J22Z（收入：2817欧元）在大型临时软组织覆盖和植皮技术中占主导地位。2017年，局部皮瓣的价值被低估，现在大多数情况下导致DRG J11D（收入：1903欧元）。在此背景下，采用两阶段方法（第1阶段：切除，第2阶段：重建）对病例进行汇总尤为重要。唇部恶性肿瘤在DRGs中的表现不一致，缺乏明确规则。通过添加特定的单一手术几乎总能达到评分较高的主要分组DRG J08（包括DRGs J08A、J08B和J08C）。
目前DRGs对恶性皮肤肿瘤重建手术的表现与潜在的抑制作用相关，这可能会对患者护理产生影响。为寻求多样化的组合，除了常规编码做法外，还应考虑主要分组DRG J08。本研究的作者认为，这可能是一种弥补实际贬值并在高成本病例中实现与资源相关报销的方法。然而，由于DRGs稀释导致缺乏长期导向，应避免不正确和过度使用。
