Comparison of the revenue situation in interventional radiology based on the example of peripheral artery disease in the case of a DRG payment system and various internal treatment charges

Purpose Calculation of process-orientated costs for inpatient endovascular treatment of peripheral artery disease (PAD) from an interventional radiology (IR) perspective. Comparison of revenue situations in consideration of different ways to calculate internal treatment charges (ITCs) and diagnosis-related groups (DRG) for an independent IR department. Materials and Methods Costs (personnel, operating, material, and indirect costs) for endovascular treatment of PAD patients in an inpatient setting were calculated on a full cost basis. These costs were compared to the revenue situation for IR for five different scenarios: 1) IR receives the total DRG amount. IR receives the following DRG shares using ITCs based on InEK shares for 2) “Radiology” cost center type, 3) “OP” cost center type, 4) “Radiology” and “OP” cost center type, and 5) based on DKG-NT (scale of charges of the German Hospital Society). Results 78 patients (mean age: 68.6 ± 11.4y) with the following DRGs were evaluated: F59A (n = 6), F59B (n = 14), F59C (n = 20) and F59 D (n = 38). The length of stay for these DRG groups was 15.8 ± 12.1, 9.4 ± 7.8, 2.8 ± 3.7 and 3.4 ± 6.5 days Material costs represented the bulk of all costs, especially if new and complex endovascular procedures were performed. Revenues for neither InEK shares nor ITCs based on DKG-NT were high enough to cover material costs. Contribution margins for the five scenarios were 1 = € 1,539.29, 2 = € –1,775.31, 3 = € –2,579.41, 4 = € –963.43, 5 = € –2,687.22 in F59A, 1 = € –792.67, 2 = € –2,685.00, 3 = € –2,600.81, 4 = € –1,618.94, 5 = € –3,060.03 in F59B, 1 = € –879.87, 2 = € –2,633.14, 3 = € –3,001.07, 4 = € –1,952.33, 5 = € –3,136.24 in F59C and 1 = € 703.65, 2 = € –106.35, 3 = € –773.86, 4 = € 205.14, 5 = € –647.22 in F59 D. InEK shares return on average € 150 – 500 more than ITCs based on the DKG-NT catalog. Conclusion In this study positive contribution margins were seen only if IR receives the complete DRG amount. InEK shares do not cover incurred costs, with material costs representing the main part of treatment costs. Internal treatment charges based on the DKG-NT catalog provide the worst cost coverage.