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[Further development of the diagnosis-related groups system--fact or fiction? Differentiation of case severities in patients with proximal femoral fractures 2003-2005].

BACKGROUND
The previous system of hospital financing based on the returns (consisting of payments received minus cost of patient treatment) is undergoing considerable changes on the basis of learning to apply the new Diagnosis-Related Groups (G-DRG) system which differentiates the financial returns according to the individual severity of each case.


AIM OF THE STUDY
1. What are the differences in cost and returns when applying the G-DRG systems 2003, 2004 and 2005 to well-defined groups of patients (for example, surgery of proximal femoral fractures)? 2. The influence exercised by secondary (supplementary) diagnosis on the grouping of the patients. 3. Has the G-DRG system been appropriately developed further in respect of improved differentiation according to severity of the cases and homogenisation of the patient groups?


PATIENTS AND METHODS
The study was based on comprehensive clinical data of 169 proximal femur fracture patients. We assessed the Case-Mix index, relative weights and returns, basic DRG, DRG, the number and weight of secondary diagnoses relevant for complexity and comorbidity levels (CCL), the summands of the CCL's and the resulting PCCL values (Patient Clinical Complexity Levels). The data were subjected to analysis of variance and graphically descriptive analysis.


RESULTS
The effective Case Mix index decreases in the 2004 and 2005 systems compared to 2003. This is due to a significant drop in returns based on an unchanged rate of receipts of 3000 . The progressive development of the systems was partly associated with major changes in grouping without significant intra-group homogenisation or improved inter-group discrimination of indications. The differentiation process does not fully utilise the differentiation potential of the basic data.


CONCLUSIONS
No definite improvement of the differentiation potential of the G-DRG systems seems to have been achieved by the 2004 and 2005 systems compared to 2003 using the data of the relevant group of patients with proximal femoral fractures. From 2005 onward the financial lumpsum receipts and returns will definitely affect hospital budgets. Hence, a substantial improvement of the the basis of calculation is imperative for 2005 as well as complete publication of the relevant data. It is indeed doubtful whether the extension of the convergence phase to 5 years presently under discussion would provide sufficient time for an adequate solution of the financial and system problems.