The Hybrid DRG system, agreed upon in the 2021 coalition agreement and introduced via Section 115f of the German Social Code, Book V (SGB V) (“special cross-sector Reimbursement”), was considered a key component in shifting medical services to the outpatient sector in the German healthcare system.
The goal was to create incentives to increasingly shift services previously provided on an inpatient basis to the outpatient sector.
As a result, the introduction of Hybrid DRGs in certain service areas has led to an increase in the volume of services provided for certain therapies. At the same time, technical peculiarities of the reimbursement system and the way services are mapped within the DRG system have made certain outpatient services significantly more economically attractive than before.
The result: Instead of declining expenditures, costs for the payers in certain areas have risen due to the Hybrid DRG system.
As a consequence, the Hybrid DRGs are to be phased out again starting in 2028. For 2027, it initially appears that the existing Hybrid DRGs will be divided into cases involving an overnight stay and same-day cases without an overnight stay. Same-day cases are to be reimbursed according to the EBM.
According to Dr. Heimig, managing director of the institute for hospital remuneration (InEK), speaking at the annual congress of the German Society for Medical Controlling (DGfM) on October 6, 2026, in Frankfurt, the existing DRG classification is to be expanded for this purpose. An expansion of the current four-digit DRG codes to six-digit codes is necessary. This will require corresponding adjustments to the DRG development grouper and will determine the timing of the publication of the 2027 DRG catalog.
These developments are of considerable importance to medtech companies. Changes to the reimbursement logic can have direct impacts on revenue potential, care pathways, investment decisions, and the economic evaluation of innovative medical technologies.
Healthcare Heads supports you in analyzing the interrelationships between the DRG system, Hybrid DRGs, EBM, and the expected changes to the reimbursement system, and in assessing the impact on therapies and products at an early stage.
We look forward to an initial discussion with you.
Author: Healthcare Heads GmbH
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