Authors: Stollhof, Laura E.
Braun, Jessica M.
Ihle, Christoph
Schreiner, Anna J.
Kufeldt, Johannes
Adolph, Michael
Wintermeyer, Elke
Stöckle, Ulrich
Nüssler, Andreas
Title: The continuous downgrading of malnutrition in the German DRG system
Other Titles: possible effects on the treatment of patients at risk for malnutrition
Language (ISO): en
Abstract: It has been internationally recognized that malnutrition is an independent risk factor for patients' clinical outcome. A new mandatory fixed price payment system based on diagnosis-related groups (G-DRG) went into effect in 2004. The aim of our study was to demonstrate the importance of carefully coding the secondary diagnosis of "malnutrition" in the G-DRG system and to highlight how the economic relevance of malnutrition in the G-DRG system has changed from 2014 to 2016. 1372 inpatient s at the Berufsgenossenschaftliche Unfallklinik (Trauma Center) in Tübingen were screened for the risk of malnutrition using Nutritional Risk Screening (NRS-2002). Patient data were compared with the NRS values collected during the study and a case simulation was carried out separately for each year. We used the codes E44.0 fo r NRS = 3 and E43.0 for NRS > 3. The ICD codes were entered as an additional secondary diagnosis in the in ternal hospital accounting system DIACOS to determine possible changes in the effective weight. In 2014 the highest additional revenue by far was calculated by coding malnutrition. For the 638 patients enrolled in the study in 2014, we were able to calculate an average additional revenue per patient coded with malnourishment of €107. In 2016, we were unable to calculate any additional revenue for the 149 patients enrolled. Although it is well known that malnutrition is an independent risk factor for poor patient outcomes, nationwide screening for a risk of malnutrition when patients are admitted to a hospital is still not required. For this reason, malnutrition in German hospitals continues to be insufficiently documented . Due to the continuous downgrading of diagnosis-related se verity (CCL) of malnutrition in the G-DRG system in trauma surgery patients, it is no longer possible to refi nance the costs incurred by malnourished patients through the conscientious coding of malnutrition. We assume that the indirect positive effects of nutritional interventions will have to be taken into account more in the costing calculations and possibly lead to indirect cost compensation.
Subject Headings: Malnutrition
Activity reimbursement
Issue Date: 2019-06-12
Rights link:
Appears in Collections:Original Articles

Files in This Item:
File Description SizeFormat 
Nuessler_12062019_proof.pdfDNB391.44 kBAdobe PDFView/Open

This item is protected by original copyright

This item is licensed under a Creative Commons License Creative Commons