𝗛𝘆𝗯𝗿𝗶𝗱 𝗗𝗥𝗚𝘀 𝗶𝗻 𝗚𝗲𝗿𝗺𝗮𝗻𝘆 – 𝗮𝗹𝗿𝗲𝗮𝗱𝘆 𝗼𝗻 𝘁𝗵𝗲 𝘄𝗮𝘆 𝗼𝘂𝘁?

Germany’s Hybrid DRG system is a reimbursement model for selected hospital services that can be provided on an inpatient or outpatient basis.

A new proposal by Germany’s governing parties would significantly change this system – and then abolish its legal basis one year later. At this stage, however, this is only a proposal and has not yet been adopted. It may still change during the legislative process.

If adopted, the transition would look like this:
𝟮𝟬𝟮𝟳
▪️ Hybrid DRG procedures without an overnight stay would no longer be reimbursed through the Hybrid DRG flat rate. Instead, reimbursement would be based on the EBM fee schedule, with respective rules for material costs.

▪️ Procedures with at least one overnight stay would continue to be reimbursed through Hybrid DRGs.

𝟮𝟬𝟮𝟴
▪️ §115f SGB V – the legal basis for Hybrid DRGs – would be repealed.

▪️ Short inpatient stays would instead move towards the new short-stay case payments (Kurzzeitfallpauschalen).

𝗕𝘂𝘁 𝘁𝗵𝗲𝗿𝗲 𝗶𝘀 𝗮𝗻 𝗶𝗺𝗽𝗼𝗿𝘁𝗮𝗻𝘁 𝗰𝗮𝘁𝗰𝗵:
Not all procedures currently covered by Hybrid DRGs have an established reimbursement pathway under the EBM/AOP framework.
If §115f SGB V is abolished, a key question will therefore be how these procedures are transferred into the outpatient reimbursement system – and how the costs of devices, implants and disposables are adequately covered.

For MedTech companies, this means that the impact may differ considerably from one technology to another. It will be important to understand where a procedure will be reimbursed in the future, whether an appropriate outpatient pathway exists, and how technology costs will be covered.

👉 At inspiring-health, we support MedTech companies in assessing exactly these questions – from analysing the current reimbursement pathway to evaluating the potential impact of upcoming changes on market access in Germany.