[Hospital financing for 2011: relevant changes in rheumatology]. / Krankenhausfinanzierung 2011 : Relevantes für die Rheumatologie.

The following article presents the major general and specific changes for rheumatology in the financing of inpatient care in Germany for 2011. In addition to relevant changes in the G-DRG classification system and coding, the new legislation and insurance company auditing procedures are covered. The impact these changes will have on hospitals specialized in rheumatology is discussed.

[The G-DRG System 2009--relevant changes for rheumatology]. / Das G-DRG-System 2010--Relevantes für die Rheumatologie.

The following article presents the major general and specific changes in the G-DRG system, in the classification systems for diagnoses and procedures as well as for the billing process for 2010. Since the G-DRG system is primarily a tool for the redistribution of resources, every hospital needs to analyze the economic effects of the changes by applying the G-DRG transition-grouper to its own cases. Depending on their clinical focus, rheumatological departments may experience positive or negative consequences from the adjustments. In addition, relevant current case law is considered.

[G-DRG system 2009: relevant changes for rheumatology]. / Das G-DRG-System 2009: Relevantes für die Rheumatologie.

The following article presents the main general and specific changes in the G-DRG (German diagnosis-related groups) system in terms of the classification systems for diagnoses and procedures as well as the billing process for 2009. Of fundamental relevance is the national weighting of the G-DRG I97Z (complex rheumatologic treatment), which up to now had to be negotiated individually by each hospital. Emphasis is also put on case auditing by the health insurers. Being primarily a tool for redistribution of resources, every hospital has to analyze the economic effects of the 2009 G-DRG system by applying the G-DRG transition grouper to its own cases. Depending on their clinical focus rheumatological departments may experience positive or negative consequences from the development. The strain imposed on hospitals by inadequate refunding of rising costs has to be assessed separately from the effects of redistribution by the G-DRG system.

[Changes for the field of rheumatology in the G-DRG-System 2007]. / Was gibt es Neues für die Rheumatologie im G-DRG-System 2007?

After extensive revision the partners of the self-administration"Selbstverwaltung" reached an amicable agreement on the new version 2007 of the G-DRG system. Like in the years before, version 2007 brings about large-scale changes for its users. A better representation of inpatient services in Germany combined with an improved economic homogeneity and appropriateness can be assumed. This is based on various factors, e. g. considerably increased data-quality and the optimization of technical influences on the system. Due to the rising level of complexity it is hardly possible to maintain a clinically homogeneous classification on the basis of G-DRGs. There is need [This calls] for a new approach in strategic matters. Various initiatives succeeded in a continuous improvement how the services provided by specialised rheumatologic clinics and departments are represented in the G-DRG system. Meanwhile, even under the pressure caused by the period of convergence, quality standards were focused on as well. The systematic changes of version 2007 as well as modifications concerning co-payments, coding and accounting rules relevant for rheumatologic clinics are presented and the consequences for users are discussed.

[What changes for rheumatologists in the G-DRG system 2006?]. / Was ändert sich für die Rheumatologie im G-DRG-System 2006?

Once more, the revision of the German DRG catalogue 2006 provides for more accurate reimbursement, particularly for specialised medical services. The newly established DRG I97Z (Rheumatologische Komplexbehandlung bei Krankheiten und Störungen an Muskel-Skelett-System und Bindegewebe) for the complex and multimodal treatment of rheumatic diseases allows an accurate picture of clinical practice in specialized rheumatologic departments and hospitals. Using this specific DRG-description, it will be possible to reduce the financial pressure which results from the redistribution of budgets in the second year of the period of convergence. A precondition for the affected hospitals is to deal with budget planning and calculation of G-DRGs without calculated cost weights for 2006. In addition, this article discusses the relevance of other modifications to the G-DRG system, additional payments, the conditions for payment, the coding standards, and the classification systems for diagnosis and procedures.

Interleukin 1beta and tumour necrosis factor alpha secreting cells are increased in the peripheral blood of patients with primary Sjögren's syndrome.

OBJECTIVE: To study systemic alterations of cytokine secreting peripheral blood mononuclear cells (PBMC) in primary Sjögren's syndrome (pSS) and their relation to common clinical and immunological manifestations of this disease. METHODS: PBMC spontaneously secreting tumour necrosis factor alpha (TNFalpha), interleukin 1beta (IL1beta), and interleukin 6 (IL6) were assessed by enzyme linked immunospot (ELISPOT) analysis in a cohort of 31 patients with pSS fulfilling the modified European classification criteria. Nineteen healthy volunteers served as controls. ELISPOT results were correlated with glandular and extraglandular manifestations and autoantibody titres-that is, rheumatoid factor (RF) isotypes, anti-Ro/SS-A, anti-La/SS-B as determined by an enzyme linked immunosorbent assay (ELISA) technique. RESULTS: The number of TNFalpha and IL1beta secreting cells was significantly higher in patients with pSS than in controls. No differences were detected in the number of IL6 secreting PBMC. Patients with recurrent parotid swelling (RPS) had a significantly increased number of IL1beta secreting PBMC. Moreover, the number of IL1beta secreting PBMC correlated with the disease duration (r(s)=0.479; p<0.01) and with the concentration of IgM RF (r(s)=0.63; p<0.01) and IgG RF (r(s)=0.42; p<0.05). Other autoantibodies did not correlate with cytokine secreting PBMC. CONCLUSION: The increased systemic secretion of IL1beta and TNFalpha in patients with pSS points to a pathogenic impact of these cytokines in this autoimmune disease. In particular the correlation of IL1beta secreting PBMC with RPS and RF production indicates that IL1beta is a crucial regulator in the development of local and systemic disease manifestations.