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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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German DRG system change in 2020

07 May 2020

Since January 1, 2020, the nursing staff costs of the hospitals are outsourced from the DRG case flat rates and financed in parallel to the DRG case flat rates using a hospital-specific care budget based on the principle of cost coverage.

The design of the new financing framework from 2020 had become necessary due to the legal changes in the Nursing Staff Strengthening Act (Gesetz zur Stärkung des Pflegepersonals (Pflegepersonal-Stärkungsgesetz - PpSG)) and represents the most sustainable change in the DRG system since its introduction. The DRGs without nursing staff costs operate under aG-DRG (“a” for “outsourced”, “ausgegliedert” in German) name. After outsourcing the nursing staff costs, the G-DRG system is now referred to as an aG-DRG system.

The basic policy of billing rules (case counting, readmission rules, relocation rules, etc.) also applies to the billing of nursing care fees. It, therefore, remains that an invoice is created for a hospital case, which includes both the DRG case flat rate and the nursing fees.

For the case flat rate catalog 2020, the annual revision did not result in a comprehensive adjustment of the DRG case flat rates and the additional fees due to the separation of nursing staff costs from the case flat rates. The case flat rate catalog is supplemented by an extra column in which the daily valuation ratios of the nursing care revenue are shown.

The full details in German can be found here.

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