DRG
Diagnosis Related Groups (Diagnosebezogene Fallgruppen)
The German reimbursement system for inpatient hospital care — it determines how much a hospital receives per patient case.
The G-DRG system reimburses inpatient hospital cases in Germany through flat-rate case payments. Each case is assigned to a case group based on diagnoses (ICD-10-GM) and procedures (OPS); InEK recalculates the weights every year. DRG logic determines which products a hospital can afford to use. The mechanism will be familiar from Medicare’s MS-DRGs; in Germany, the G-DRG covers acute inpatient care across all payers.
In practice in the German hospital market
Anyone who wants to sell into German hospitals has to master the DRG argument — that is, to demonstrate that the product is either mapped within the DRG, triggers an additional payment (an NUB or ZE application), or shortens the length of stay enough to make the flat-rate case more profitable.
How a medical device enters reimbursement
The hospital is not reimbursed for the price of a device; it receives the flat-rate case payment. Material costs — from catheters to implants — are included in it. Since 2020, nursing staff costs have been carved out into a separate nursing budget; all other costs remain in the flat rate.
The calculation is based on the actual costs of a sample of calculation hospitals. The data year lies two years before the catalogue year. A new, more expensive device is therefore initially a cost factor for the hospital until the calculation reflects it.
Three routes for new devices
NUB — new diagnostic and treatment methods
Hospitals submit an NUB request to InEK by 31 October of each year for the following year. If the method receives status 1, the hospital can agree an individual, time-limited NUB payment with the health insurers.
If the method is based mainly on a high-risk-class medical device with a new theoretical-scientific concept, the G-BA also carries out an assessment under Section 137h of the Social Code Book V. The hospital submits the information for this in agreement with the manufacturer.
Additional payments (ZE)
For services and devices that cannot be appropriately reflected in a flat-rate case payment, there are additional payments (Zusatzentgelte). They are either valued uniformly nationwide or negotiated individually by each hospital. Many additional payments started out as NUB payments.
OPS code
For a device to become visible in the calculation at all, the associated procedure often needs an OPS code of its own. The OPS is maintained by BfArM; proposals for changes go through an annual proposal procedure.
What the hospital reform changes
With the Hospital Care Improvement Act (KHVVG) and its subsequent amendments, part of the remuneration is gradually being converted into a standby payment for maintaining capacity, which no longer depends directly on case numbers. Flat-rate case payments remain in place for the rest.
More important for manufacturers are the service groups (Leistungsgruppen): they will determine which hospitals may perform which procedures. Selecting target hospitals for a market entry will therefore depend more heavily on which hospitals have been assigned the relevant service group.
How MEX supports you
The DRG calculation is part of our sales module: before market entry we assess how your device is reflected in reimbursement and which route for innovations is available. This becomes the additional-revenue case that hospital purchasing and controlling work with.
Frequently asked questions
- Can a manufacturer submit an NUB request itself?
- No. NUB requests are submitted exclusively by hospitals to InEK. Manufacturers support them with device, cost and study data — which is why early partner hospitals matter so much for innovations.
- What is the deadline for an NUB request?
- The deadline is 31 October of each year for the following year. Missing it usually costs a full year.
- Is the hospital reimbursed for the price of my device?
- Usually not. Material costs are part of the flat-rate case payment. A device pays off for the hospital if it is reflected in the flat rate, triggers an additional payment, or saves costs elsewhere — for example through a shorter length of stay.
Source: InEK — Institute for the Hospital Remuneration System