OBJECTIVES: Medical innovations are usually not covered by the German Diagnosis Related Group (DRG) system. In order to address this issue an application system for so called new examination and treatment methods (NUB) has been implemented. Hospitals annually submit NUB specific data to the Institute for the Hospital Remuneration (InEK) to explain why the current DRG remuneration is insufficient. Based on a positive decision by the InEK, an individual fee can be negotiated between hospitals and the statutory health insurances (SHI). Negotiation results are confidential and data is only partly publicly available. This study represents the first analysis of real world data on NUB remuneration.

METHODS: Hospital claims data were used to detect all individual fees for NUB billed to SHI between 2013 and 2017 and matched with the annually published InEK database. An analysis of negotiated fees concerning level, quantity and revenue was executed. Analysis also includes a differentiation on the type of NUB (pharmaceuticals, medical devices, medical procedures).

RESULTS: In total, applications for 1,082 NUB were filed to InEK between 2013 and 2017. Individual fees were ultimately billed only for 207 (19.1%) NUB. Of these, 54.1% accounted for pharmaceuticals, 37.2% for medical devices and 8.7% for medical procedures. In 78.4% of all NUB the invoice was based on a positive assessment (status 1) by the InEK. In contrast 38 NUB were invoiced to the SHI based on other legal claims. The total NUB based revenue increased between 2013 and 2017 from 73.3 million to 233.5 million euros. This translates to a 0.2% increased share of the annual SHI expenditures for inpatient services.

CONCLUSIONS: Data indicates that just for a low number of NUB individual fees are negotiated and billed to the SHI. Due to the high and rising fees SHI expenditures for NUB increased in the period under review.