The German DRG Institute (InEK) published the catalogue for the investment cost weights (“Investitionsbewertungsrelationen”, German abbr.: IBR) on July 6th.
Basically, the IBR is calculated with the so-called "Einhaus method". How the IBR were calculated this year and whether there have been changes compared to previous years is currently not comprehensible, as the corresponding final report has not yet been published. The representativeness and appropriateness of the "Einhaus method" remains questionable for us. This method averages the investments of all participating hospitals. The average is then used as the "standard" for all hospitals. Thus, the selection of hospitals participating in this calculation has a great influence on the result. The low investments of the past are thus defined as a standard.
For example, surgeries can be performed conventionally – (e. g. via open surgery) – or minimally invasive (e. g. robotic assisted surgery). Such minimally invasive techniques have a significantly higher investment effort, but at the same time also a much shorter length of stay with faster convalescence in contrast to open surgeries.
The IBR consists of a case individual part and a LOS individual part which leads (e. g. In robotic assisted surgeries with typically shorter LOS) not only to a disadvantage for the DRG Reimbursement but also in the IBR Reimbursement. DRGs are not differentiated regarding robotic assisted surgery with high investment costs is used or how the digitization in the individual hospitals looks like.
These facts lead to a more or less random composition of the IBR and a systematic funding shortage of hospitals investing in infrastructure for optimizing patient care. The DRG-system in general and hospital funding are criticized more than ever.
With the calculation of the IBR, the InEK itself has the opportunity to solve this problem.
We are looking forward to the final report and the possible amendments of the IBR calculation for 2021.
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