Reimbursement by current German Diagnosis-Related Groups system penalises complex congenital heart surgery

2013 ◽  
Vol 24 (2) ◽  
pp. 344-350 ◽  
Author(s):  
Nicodème Sinzobahamvya ◽  
Thorsten Kopp ◽  
Claudia Arenz ◽  
Hedwig C. Blaschczok ◽  
Viktor Hraska ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
Congenital Heart Surgery ◽  
German Diagnosis Related Groups ◽  
Complexity Score ◽  
Highly Correlated

AbstractA total of 458 hospital stays during the year 2011 were analysed to determine whether reimbursement by the current German Diagnosis-Related Groups system covers the costs incurred during hospital stay for congenital heart surgery. The costs of every hospital stay were estimated according to the guidelines of the Institute for the Hospital Remuneration System, an institute responsible for encoding hospital reimbursement in Germany. Cost-weight values of the year 2012 were applied for reimbursement. Related additional compensations were also included. Hospital costs ranged from 8896.26 to 193,671.94 euros per case, with a mean of 30,597 and standard deviation of 25,032 euros. Reimbursement varied from 8630.35 to 173,710.65 euros, with a mean of 25,514 and standard deviation of 18,497 euros: an underfunding of 17%. Fifty-nine per cent (271/458) of cases were classified, according to Aristotle complexity score, in higher comprehensive complexity: Levels 4–6. Costs highly correlated with complexity levels (Spearman's r coefficient = 0.89) and the regression was linear. Underfunding increased, linearly, from 6% for procedures with Level 1, lowest comprehensive complexity, to 23% for those with Level 6, highest complexity. In conclusion, this study demonstrates that reimbursement by the current German Diagnosis-Related Groups system increasingly penalises complex congenital heart surgery. Aristotle complexity score could help to correct this prejudicial situation.

scholarly journals Accuracy of the All Patient Refined Diagnosis Related Groups Classification System in Congenital Heart Surgery

2014 ◽  
Vol 97 (2) ◽  
pp. 641-650 ◽  
Author(s):  
Aimee S. Parnell ◽  
Justine Shults ◽  
J. William Gaynor ◽  
Mary B. Leonard ◽  
Dingwei Dai ◽  
...  
Keyword(s):  
Classification System ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Diagnosis Related Groups ◽  
Congenital Heart Surgery

Reducing readmissions following paediatric cardiothoracic surgery: a quality improvement initiative

2014 ◽  
Vol 25 (5) ◽  
pp. 935-940 ◽  
Author(s):  
Brian Kogon ◽  
Kim Woodall ◽  
Kirk Kanter ◽  
Bahaaldin Alsoufi ◽  
Matt Oster
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Failure To Thrive ◽  
Congenital Heart Surgery ◽  
Cardiothoracic Surgery ◽  
Hispanic Ethnicity ◽  
Multivariate Risk ◽  
Initial Hospital

AbstractBackground: We have previously identified risk factors for readmission following congenital heart surgery – Hispanic ethnicity, failure to thrive, and original hospital stay more than 10 days. As part of a quality initiative, changes were made to the discharge process in hopes of reducing the impact. All discharges were carried out with an interpreter, medications were delivered to the hospital before discharge, and phone calls were made to families within 72 hours following discharge. We hypothesised that these changes would decrease readmissions. Methods: The current cohort of 635 patients underwent surgery in 2012. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate and multivariate risk factor analyses were performed. Comparisons were made between the initial (2009) and the current (2012) cohorts. Results: There were 86 readmissions of 77 patients during 2012. Multivariate risk factors for readmission were risk adjustment for congenital heart surgery score and initial hospital stay >10 days. In comparing 2009 with 2012, the overall readmission rate was similar (10 versus 12%, p=0.27). Although there were slight decreases in the 2012 readmissions for those patients with Hispanic ethnicity (18 versus 16%, p=0.79), failure to thrive (23 versus 17%, p=0.49), and initial hospital stay >10 days (22 versus 20%, p=0.63), they were not statistically significant. Conclusions: Potential risk factors for readmission following paediatric cardiothoracic surgery have been identified. Although targeted modifications in discharge processes can be made, they may not reduce readmissions. Efforts should continue to identify modifiable factors that can reduce the negative impact of hospital readmissions.

scholarly journals Center Variation in Hospital Costs for Patients Undergoing Congenital Heart Surgery

2011 ◽  
Vol 4 (3) ◽  
pp. 306-312 ◽  
Author(s):  
Sara K. Pasquali ◽  
Jie-Lena Sun ◽  
Phil d'Almada ◽  
Robert D.B. Jaquiss ◽  
Andrew J. Lodge ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Hospital Costs ◽  
Congenital Heart Surgery

Abstract 220: Technical Performance Scores Predict Outcomes Following Congenital Heart Surgery: Multicenter Validation

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Meena Nathan ◽  
Hua Liu ◽  
Steven D Colan ◽  
Lazaros Kochilas ◽  
Geetha Raghuveer ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Assessment Tool ◽  
Multivariable Analysis ◽  
Congenital Heart Surgery ◽  
Hospital Length Of Stay ◽  
Atrioventricular Canal ◽  
Technical Performance

BACKGROUND: In previous work from a single center, Technical Performance Score (TPS), a tool that assesses technical adequacy of repair, has been shown to be strongly associated with outcomes in congenital cardiac surgery. We sought to validate the efficacy of TPS in a multicenter environment. METHODS: All patients (1 day to 62 years) who were discharged from January 1 to December 31, 2011; and who underwent 9 congenital cardiac procedures (Arterial switch operation [84], Bidirectional Glenn [75], Atrioventricular canal repair [135], Fontan [97], Arch repair on pump [58], Stage I Procedure [85], Pulmonary valve replacement [116], Tetralogy of Fallot repair [112], and Ventricular septal defect repair [163]); from 5 centers were included. Based on echocardiograms (echo) prior to discharge or death, and unplanned reinterventions at surgical site; TPS was assigned using previously established criteria. Case complexity was determined by RACHS-1 category. Outcomes included (a) major postoperative adverse events (AE) excluding unplanned reinterventions, (b) length of ventilation, and (c) postoperative hospital stay. Adjusted analysis used logistic/linear regression to determine odds ratio (OR) and regression coefficient (b) for each outcome. RESULTS: There were 925 hospital discharges: 418 (45%) were RACHS-1 category 2, 295 (32%) category 3, 85 (9%) category 4, 86 (9%) category 6 and the cohort included 41 (4%) adults. TPS were as follows: 491 (53%) class 1-optimal, 263 (28%) class 2-adequate, 131 (14%) class 3-inadequate and 40 (4%) had no TPS assigned because of a lack of or incomplete echos (NA). There were 26 (2.8%) deaths (81% of deaths were in class 3) and 105 (11%) adverse events. Occurrence of major adverse events, ventilation time and hospital length of stay were all significantly higher in class 3 (Figure). On multivariable analysis adjusting for age, RACHS-1, prematurity, and presence of non-cardiac anomalies; Class 3 TPS was associated with a higher odds of AE (OR 7.4, CI 4.1-13.2, p<0.001), longer ventilation (b 1.9, CI 1.6-2.2, p<0.001), and hospital stay (b 1.6, CI 1.4 to 1.8, p<0.001). CONCLUSION: TPS predicts outcomes after congenital heart surgery in a multicenter cohort, and can serve as quality assessment tool. Outcomes may be favorably influenced by focusing on technical excellence.

Evaluation of the Quality of Care in Congenital Heart Surgery: Contribution of the Aristotle Complexity Score

2007 ◽  
Vol 54 (1) ◽  
pp. 67-83 ◽  
Author(s):  
Francois Lacour-Gayet ◽  
Jeffrey P. Jacobs ◽  
David R. Clarke ◽  
Bohdan Maruszewski ◽  
Marshall L. Jacobs ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Complexity Score

scholarly journals Congenital heart surgery: surgical performance according to the Aristotle complexity score

2011 ◽  
Vol 39 (4) ◽  
pp. e33-e37 ◽  
Author(s):  
Claudia Arenz ◽  
Boulos Asfour ◽  
Viktor Hraska ◽  
Joachim Photiadis ◽  
Christoph Haun ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Surgical Performance ◽  
Complexity Score

Stratification of complexity: The Risk Adjustment for Congenital Heart Surgery-1 Method and The Aristotle Complexity Score – past, present, and future

2008 ◽  
Vol 18 (S2) ◽  
pp. 163-168 ◽  
Author(s):  
Marshall Lewis Jacobs ◽  
Jeffrey Phillip Jacobs ◽  
Kathy J. Jenkins ◽  
Kimberlee Gauvreau ◽  
David R. Clarke ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Quality Of Care ◽  
Risk Adjustment ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Case Mix ◽  
Objective Data ◽  
Complexity Score

AbstractMeaningful evaluation of quality of care must account for variations in the population of patients receiving treatment, or “case-mix”. In adult cardiac surgery, empirical clinical data, initially from tens of thousands, and more recently hundreds of thousands of operations, have been used to develop risk-models, to increase the accuracy with which the outcome of a given procedure on a given patient can be predicted, and to compare outcomes on non-identical patient groups between centres, surgeons and eras.In the adult cardiac database of The Society of Thoracic Surgeons, algorithms for risk-adjustment are based on over 1.5 million patients undergoing isolated coronary artery bypass grafting and over 100,000 patients undergoing isolated replacement of the aortic valve or mitral valve. In the pediatric and congenital cardiac database of The Society of Thoracic Surgeons, 61,014 operations are spread out over greater than 100 types of primary procedures. The problem of evaluating quality of care in the management of pediatric patients with cardiac diseases is very different, and in some ways a great deal more challenging, because of the smaller number of patients and the higher number of types of operations.In the field of pediatric cardiac surgery, the importance of the quantitation of the complexity of operations centers on the fact that outcomes analysis using raw measurements of mortality, without adjustment for complexity, is inadequate. Case-mix can vary greatly from program to program. Without stratification of complexity, the analysis of outcomes for congenital cardiac surgery will be flawed. Two major multi-institutional efforts have attempted to measure the complexity of pediatric cardiac operations: the Risk Adjustment in Congenital Heart Surgery-1 method and the Aristotle Complexity Score. Both systems were derived in large part from subjective probability, or expert opinion. Both systems are currently in wide use throughout the world and have been shown to correlate reasonably well with outcome.Efforts are underway to develop the next generation of these systems. The next generation will be based more on objective data, but will continue to utilize subjective probability where objective data is lacking. A goal, going forward, is to re-evaluate and further refine these tools so that, they can be, to a greater extent, derived from empirical data. During this process, ideally, the mortality elements of both the Aristotle Complexity Score and the Risk Adjustment in Congenital Heart Surgery-1 methodology will eventually unify and become one and the same. This review article examines these two systems of stratification of complexity and reviews the rationale for the development of each system, the current use of each system, the plans for future enhancement of each system, and the potential for unification of these two tools.

Congenital Heart Surgery: Expected Versus Observed Surgical Performance According to the Aristotle Complexity Score

2011 ◽  
Vol 59 (05) ◽  
pp. 268-273 ◽  
Author(s):  
J. Photiadis ◽  
N. Sinzobahamvya ◽  
C. Arenz ◽  
S. Sata ◽  
C. Haun ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Surgical Performance ◽  
Complexity Score
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