Reimbursement in Endoscopy: How Can New Procedures Be Implemented?

BACKGROUND: New procedures in endoscopy take time to be incorporated in the German diagnosis-related groups (DRG) system. Depending on the extent of innovation and the costs, several pathways are possible. METHODS: This article provides an overview of possible pathways to implement new procedures in the German DRG payment system. Additionally, we compare the results of 2 surveys on the system of New Diagnostic and Treatment Methods (Neue Untersuchungs- und Behandlungsmethoden; NUB). Furthermore, the pathways of 2 innovations in endoscopy are described in detail and compared with the possibilities within the legal framework. RESULTS: The different pathways like NUB applications or DRG change requests and the underlying legal framework are described in detail. The results of a survey from 2007 on the daily practice of NUB funding in Germany show that the extent of innovations which receive a positive assessment (status 1) is 46% compared to 43.7% in a survey from 2007, and that 77% of the status 1 procedures (and drugs) can be negotiated into a payment - compared to 53% in the older survey. CONCLUSION: Medical scientific societies should be involved in this process from the beginning. Besides the importance for the hospital application process (81.3% of all medical controllers want to have society support), the regulatory bodies (e.g. DIMDI, InEK, G-BA) also appreciate scientific statements. Two examples show the pathways in detail. For radiofrequency ablation of Barrett's esophagus, the pathway of continuous change requests was chosen, while the endoluminal conduit for the treatment of type 2 diabetes was established as NUB payment.

Building a knowledge base for systems pathology.

Translating the exponentially growing amount of omics data into knowledge usable for a personalized medicine approach poses a formidable challenge. In this article-taking diabetes as a use case-we present strategies for developing data repositories into computer-accessible knowledge sources that can be used for a systemic view on the molecular causes of diseases, thus laying the foundation for systems pathology.

EndoNet: an information resource about regulatory networks of cell-to-cell communication.

EndoNet is an information resource about intercellular regulatory communication. It provides information about hormones, hormone receptors, the sources (i.e. cells, tissues and organs) where the hormones are synthesized and secreted, and where the respective receptors are expressed. The database focuses on the regulatory relations between them. An elementary communication is displayed as a causal link from a cell that secretes a particular hormone to those cells which express the corresponding hormone receptor and respond to the hormone. Whenever expression, synthesis and/or secretion of another hormone are part of this response, it renders the corresponding cell an internal node of the resulting network. This intercellular communication network coordinates the function of different organs. Therefore, the database covers the hierarchy of cellular organization of tissues and organs as it has been modeled in the Cytomer ontology, which has now been directly embedded into EndoNet. The user can query the database; the results can be used to visualize the intercellular information flow. A newly implemented hormone classification enables to browse the database and may be used as alternative entry point. EndoNet is accessible at: http://endonet.bioinf.med.uni-goettingen.de/.

TRANSPATH: an information resource for storing and visualizing signaling pathways and their pathological aberrations.

TRANSPATH is a database about signal transduction events. It provides information about signaling molecules, their reactions and the pathways these reactions constitute. The representation of signaling molecules is organized in a number of orthogonal hierarchies reflecting the classification of the molecules, their species-specific or generic features, and their post-translational modifications. Reactions are similarly hierarchically organized in a three-layer architecture, differentiating between reactions that are evidenced by individual publications, generalizations of these reactions to construct species-independent 'reference pathways' and the 'semantic projections' of these pathways. A number of search and browse options allow easy access to the database contents, which can be visualized with the tool PathwayBuildertrade mark. The module PathoSign adds data about pathologically relevant mutations in signaling components, including their genotypes and phenotypes. TRANSPATH and PathoSign can be used as encyclopaedia, in the educational process, for vizualization and modeling of signal transduction networks and for the analysis of gene expression data. TRANSPATH Public 6.0 is freely accessible for users from non-profit organizations under http://www.gene-regulation.com/pub/databases.html.

Deriving an ontology for human gene expression sources from the CYTOMER database on human organs and cell types.

CYTOMER is a relational database of organs/tissues, cell types, physiological systems and developmental stages that currently focuses on the human system. From this database, we have derived an ontology for anatomical and morphological structures for the human organism which includes all embryonal stages and the cell types constituting these structures. The ontology has been transferred to the OWL format and is freely available for download at http://cytomer/bioinf.med.uni-goettingen.de.