ABSTRACT
BACKGROUND: Depressive comorbidity is common with physically ill inpatients and is associated with many negative medical and economic effects (e. g., increased morbidity and mortality, increased length of stay, poorer quality of life and increased utilization of health services). The aim of this study is to clarify the question whether the additional costs caused by comorbid depressive diseases are recovered by additional G-DRG-specific revenues in order to finance necessary diagnostics and therapies of this comorbidity. METHODS: We analysed the revenues generated by depressive secondary diagnoses. Consequently, we selected patients with relevant F-diagnoses according to ICD-10 from billing data of the University Hospital Greifswald between 2010 and 2014. We recoded each case without a comorbid depression, taking into account the specifications of the relevant accounting year. Subsequently, the revenues with and without coding the comorbidity were compared (n=6,563). RESULTS: In 115 out of 6,563 patients (1.75%), mainly with unspecific recurrent depressions, the documentation and coding of a comorbid depression led to a change in the proceeds. Taking into account the applicable base rate between 2010 and 2014, the coding leads to an additional revenue of 216,737.01 Euro for the entire observation period. This corresponds to an increase of approximately 1,885 Euro per patient (n=115). In relation to the total number of patients with comorbid depressions (n=6,563) it is a surplus of 33.02 Euro. However, predominantly unspecific depressive diagnoses (e. g., F 32.8) are encoded, which do not increase the level of severity in the DRG system and, thus, have no effect on the proceeds. DISCUSSION: In very few cases, the inclusion of depressive comorbidities leads to an increase in revenue. Only some depressive diagnoses have a CCL. Due to the relatively low CCL (1 or 2), depressive comorbidities often show no effect on PCCL of multimorbid patients. Currently there is no adequate financial incentive for the hospitals to recognize and treat depressions, since the additional costs do not lead to increased revenues. In the context of a systemic treatment, depression will have to be taken into account more strongly in the financing system, especially in view of the numerous negative effects of this comorbidity.
