• Michael Cerny, Susanne Hellmich, Ulrike Schwarz-Boeger, Daniel Schmauss, Philipp Moog, Anna-Theresa Bauer, Dominik Pförringer, Holger Erne, Hans-Günther Machens, and Kai Megerle.
• Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, Klinikum rechts der Isar.
• Handchir Mikrochir Plast Chir. 2018 Aug 1; 50 (4): 284-290.

BackgroundThe treatment of complex patients with chronic wounds, such as pressure ulcers, is often not adequately reimbursed in patients with need for daily intensive care due to multimorbidity and chronic co-diagnoses. The present study analyses revenues, principle cost factors as well as possible complications.MethodsWe analysed 51 patients with the DRG principle diagnosis of decubitus stage III and IV, treated in our maximum care clinic in 2014 and 2015. Duration of stay, count of surgical procedures as well as frequency and type of complication were analysed. Costs and revenues per patient were calculated and compared to the mean costs stated by the institute of revenue and costs calculations (InEK).ResultsIn 25 of 51 cases, the costs exceeded the revenues, which was due to an excessively long stay at the hospital, complications or a large number of operative procedures. On average, the patients could not be treated cost-efficiently at our clinic.ConclusionThe treatment of most multimorbid patients with decubital ulcers is often not adequately reimbursable within the German DRG system. A strict treatment algorithm with a reduced number of operations and intensive patient care are helpful approaches, but may not be sufficient to reduce cost-intensive complications. It seems important to re-evaluate the current DRG codes for these cases.© Georg Thieme Verlag KG Stuttgart · New York.

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