Patient classification in rehabilitation as a basis for performance-related payments

Introduction

Since Germany introduced a comprehensive system for its acute-care sector, post-acute rehabilitation is under economic pressure. Patients are referred earlier and less healed to rehabilitation clinics. In addition, “payers” are not willing to pay more for post-acute rehabilitation. This situation requires an adequate classification system for rehab patients.

Methods

There are several proposals to solve the problem described in Germany. One approach is the “patient classification system for rehab patients” which was developed by the Institute of Health-Economics (IfG). It will be described in the following section.

Following the logic of DRG, the system starts with major indication fields like musculoskeletal disorder, neurology, etc. In the next step, with the assistance of rehabilitation physicians, we defined basic rehabilitation treatment groups (RTGs/RBGs) for each indication field. As a result, we found 7 basic groups and 12 severity groups for orthopaedics, and 10 basic groups and 13 severity groups for cardiology.

Results

In cooperation with 10 rehab clinics, we calculated the average costs for each RTG. By grouping, we found out a coefficient of determination (R^2) of 0.4. By defining the various subgroups via the “Barthel-Index”, we were able to improve the coefficient of determination (R^2) by a further 5 percentage points.

Conclusions

At the conference we would like to discuss our results, methods and how to establish a performance-based compensation system for our RTGs. Moreover, we would like to think about how RTGs and DRGs can be assembled to determine complex lump-sum rates (“Komplexpauschalen”). Another question to be discussed is how health insurance funds can be included in this process.