Effect of Malnutrition Coding in the SwissDRG-System

Background Disease-related malnutrition (DRM) in hospitals is a frequent problem with medical and economic consequences. The present four-years-analysis shows whether the expenses for nutritional therapies of malnourished patients get covered by the surplus, which is attained from the encoding of DRM in the SwissDRG-system. Material and Methods All inpatients with an E 4-diagnosis of the University Hospital of Bern were analyzed in this data collection (2013 - 2016). The E-diagnosis, diagnosis, length of hospital stay, age, type of nutritional therapy, surplus and costs generated by the nutritional treatment were considered. The expenses for the nutrition counseling, care and nutritional therapies were extrapolated. Further, the patients were divided into 12 groups (based on the ICD-10 classification of the WHO), due to their principal diagnosis. Results Of the 169515 inpatients in the observed four years, 5442 cases (3.2%) were coded as malnourished. Only 462 cases (8.5 %) increased the relative weight, and hence, the amount of total reimbursement of the assigned DRM. Of the 5442 patients, 3211 (59%) received oral nutritional supplements, 1578 (29%) enteral nutrition and 654 (12%) parenteral nutrition. The encoding of DRM amounted to a surplus of total CHF 3 494 081 and an effort of extrapolated CHF 2 803 432. Oncological patients were most often encoded with DRM (n = 1708, 31.4 %), followed by patients with diseases of the digestive system (n = 671, 12.3 %) and of the circulatory system (n = 609, 11.2%). Conclusion This analysis shows, that the surplus generated by the encoding of DRM in the SwissDRG-system, covers the financial effort resulting from nutritional therapies. The consequent and early assessment, treatment and encoding of DRM lead to a high treatment quality and patient safety and is economically viable for the hospital.