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Berlin The Federal Association of German Pathologists (BDP) criticizes the hybrid DRGs that already exist and those that will be introduced next year. From the association’s point of view, there is a significant regulatory gap that stands in the way of outpatient care and can worsen patient care.

This concerns the billing of pathology services after an operation. The wording of the hybrid DRG regulation does not clearly indicate that pathology services are included, criticises the BDP.

On the other hand, the hybrid DRG flat rates calculated by the Institute for the Hospital Remuneration System (InEK) include pathology services.

According to the association, these contradictory regulations lead to ambiguities: Some associations of statutory health insurance physicians (KVs) consider pathology as part of the laboratory costs and as covered by the hybrid DRG and point out that the service providers have to agree among themselves.

Other KVs rely on the text of the hybrid DRG agreement. According to this, pathological services are to be ordered via referral form and the service itself can be billed accordingly using the uniform assessment scale.

According to the association, the core problem is that pathological diagnostics cannot be planned and calculated in general. In contrast to a planned surgical procedure, the extent and complexity of pathological diagnostics of removed tissue cannot be planned in advance, according to the BDP.

The BDP is therefore calling for pathological diagnostics to be remunerated outside of the hybrid DRG flat rate. The hybrid DRG does not reflect the actual costs, nor can the individual service providers bear the incalculable risk of pathological costs that cannot be calculated in advance, the association explained. © hil/aerzteblatt.de