Hybrid-DRGs – a new reimbursement system for cross-sector care

Since January 1, 2024, it is possible for medical service providers in the inpatient sector as well as the outpatient sector to bill uniform rates for identical treatments. This means that, for the first time, the reimbursement for a certain set of medical services will be the same across sectors, regardless of whether they are provided by contracted physicians or in a hospital.

The political objective behind this legislation is to reach at least one million inpatient treatment cases annually that will be reimbursed through Hybrid-DRGs starting in 2026. In 2028, this figure is set to rise to 1.5 million, and in 2030 to at least 2 million cases.

To achieve these target numbers, in 2026 inpatient treatment cases that have never before been provided in the outpatient sector will also be reimbursed via Hybrid-DRGs. At the same time, the definition of Hybrid-DRGs will be expanded, also regarding the length of stay. As a result, starting in 2026, the set of Hybrid-DRG services will include treatments that in the past have been exclusive to the inpatient sector. They will initially still be only provided in hospital, yet they cannot be billed through the DRG system - instead, they will be billed using Hybrid-DRGs. This can prove advantageous or might effect the reimbursement negatively.

Impacts and Opportunities

This paradigm shift comes while the German federal states implement massive changes in the way they do their hospital planning including the new service groups and pre-reimbursement. How a treatment case is assigned to Hybrid-DRGs follows similar principles to those used for assigning inpatient treatment cases to DRGs for reimbursement. The introduction of Hybrid-DRGs aims to create incentives to move patients out of the inpatient sector. Service providers and the MedTech industry now face challenges, but above all, new opportunities.

To take advantage of these opportunities, it is crucial for international companies to truly understand the Hybrid-DRG system and its impact on the DRG system in order to successfully launch products on the German market.

Strategic Consulting by Healthcare Heads

Now is the time to find out about the new regulations and future developments so that strategies can be adapted for a successful future.

Healthcare Heads is your navigator through the German healthcare system. We will inform you about all the latest developments and emerging opportunities and provide you with strategic and operational support throughout this transformation.