Considerations on the surgical treatment of Duct Carcinoma in Situ (DCIS) of the breast from DRG system perspective

Medical services for the treatment of Duct Carcinoma In Situ (DCIS) may be delivered in inpatient or outpatient care conditions. The aim of this study was to identify services recommended during patient hospitalization, and those more suitable for outpatient health care services, as well as measures to optimize the management of these cases from the reimbursement of medical services system perspective. PATIENTS AND METHODS: We conducted our study on the case records of the Oncological Institute „Prof. Dr. Ion Chiricuţă” Cluj-Napoca (IOCN) over a period of five years (2008–2012). RESULTS: Analysis of the 129 cases of patient hospitalization showed that for the mastectomies performed the mean relative value (VR) for the discharged cases was slightly greater that the referential VR stated in the reimbursement framework contract (VR for IOCN discharged case was 1.2529 vs. 1.2097 referential VR in the contract). VR for the cases discharged after hospitalization in which a local excision had been performed was 0.6778 compared to 0.5482 the referential VR from the reimbursement contract. In the same period, the entity-specific flat-rate reimbursement for local excisions varied from 539 RON to 360 RON, depending on the year. CONCLUSIONS: Our study concludes that the treatment of DCIS cases did not negatively influence IOCN funding. In addition, it recommends the negotiation of combined services packages for the lesions that require imaging localization.