The continuous downgrading of malnutrition in the German DRG system
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Date
2019-06-12
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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.
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Keywords
Malnutrition, G-DRG, Activity reimbursement, NRS