The role of medical devices in influencing in-hospital sustainability: an analysis of expenditure in 2019 vs DRG reimbursement according to major medical specialties in a region of middle Italy

ABSTRACT

Introduction

Very limited information exists from Italian hospitals about the utilization and expenditure of medical devices. The ratio expenditure/DRG reimbursement (expressed as a percentage) is a useful parameter, particularly when it is separately calculated for each individual Azienda and, within each Azienda, according to the medical discipline.

Areas covered

To generate benchmarks in this area, we have made reference to the expenditure incurred for medical devices from January to June 2019 in all hospitals of the Tuscany region. These expenditures divided by medical discipline have been compared with the DRG reimbursements that hospitals receive from our Region for the same disciplines. This benchmark is represented by percent ratio expenditure/reimbursement for each of the eight Aziende and, within each Azienda, according to the medical specialty.

Expert opinion

These percentages indicate, for each medical discipline, to what extent medical devices typically consume the reimbursement resulting from the DRGs. These benchmarks facilitate the interpretation of values estimated locally. Determinants leading to ‘excessive’ values (e.g. >100%) of this parameter can include an extensive use of costly devices, a high frequency of non-remunerative procedures, the presence of inappropriate treatments, the need to update specific DRGs, deficiencies in coding expenditures and procedures, and so on.

KEYWORDS:

• DRG
• hospital expenditure
• expenditure vs reimbursement medical devices
• clinical activity
• sustainability

Article highlights

• In the hospitals of an Italian region, we evaluated the expenditure for medical devices in comparison with the reimbursement resulting from the DRGs.

• This ratio was determined as overall ratio for the whole hospital and for individual medical disciplines. The objective was to provide a series of benchmarking values along with the between-hospital variability of this parameter.

• University hospitals had a much higher expenditure than general hospitals particularly as regards highly specialized medical disciplines.

• To our knowledge, the information described in our study has rarely been published in previous reports

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper was not funded.