Hybrid Diagnosis-Related Groups (Hybrid DRG)

The German healthcare system is at a long-overdue crossroads. Starting in 2026, a cross-sector reimbursement model will become part of daily operations at hospitals and medical care centers (MVZs) for the first time with hybrid case-based flat rates, called “Hybrid Diagnosis-Related Groups” (Hybrid DRG). What initially appears to be a billing technicality will have far-reaching consequences for the IT architecture behind the scenes.

The new reimbursement logic requires patient data, documentation processes, and billing systems to be consistently available across sector boundaries. Hospital architects have been planning in service groups for years. Now, their IT colleagues face a similarly fundamental task.

What happens when integration is lacking

Those who integrate medical care centers into a growing holding structure are all too familiar with the consequences of a lack of IT consolidation in day-to-day operations. Without a shared database, you end up with parallel patient records, inconsistent billing data, and an almost insurmountable mess of interfaces. Under Hybrid DRG, there is an added revenue risk: Those who cannot accurately document cases across sectors cannot code them correctly, resulting in lost revenue.

Added to this is the regulatory dimension. The ePA has been mandatory for medical facilities since October 2025. According to a survey by the German Hospital Institute (DKI), by the end of 2025, approximately one-quarter of hospitals did not anticipate achieving hospital-wide implementation until the second quarter of 2026. Common reasons include HIS interface problems and insufficient preparation by software vendors.

Closing this gap requires time, a structured approach, and clear prioritization.

The methodological roadmap: Maturity model before infrastructure projects

Before building a new IT architecture, it is essential to assess the current state honestly. Without this understanding, investments are made on a hunch. A structured approach makes more sense. First, all relevant systems and processes are assessed. Then, they are classified within a maturity model. Finally, a prioritized action plan is created based on the assessment and classification.

In our projects, which have integrated IT-driven medical center structures into holding company landscapes, three areas of action have emerged as particularly impactful:

1. Consolidating the interface architecture based on modern interoperability standards.
2. Integrating the ePA into actual clinical workflows rather than treating it as a technical add-on.
3. Implementing a binding supplier management framework with clear service-level agreements with HIS vendors and other IT suppliers.

These steps do not require a complete overhaul. Many facilities can build on existing infrastructure once the gaps are identified. An IT maturity assessment provides this visibility.

If you would like to assess your institution’s current standing and the greatest impact of potential measures, please contact us.

Sources

• Vescia, F., & Deegener, T. (2025). A German perspective on hybrid diagnosis-related group. Current Opinion in Anaesthesiology.
• Torab-Miandoab, A., et al. (2023). Interoperability of heterogeneous health information systems: a systematic literature review. BMC Medical Informatics and Decision Making.
• Rau, E., Tischendorf, T., & Mitzscherlich, B. (2024). Implementation of the electronic health record in the German healthcare system. Frontiers in Health Services.
• Von Dercks, N., et al. (2024). Chancen und Risiken in der Ambulantisierung der Unfallchirurgie und Orthopädie. Die Chirurgie.
• German Hospital Institute (DKI): Flash survey on the introduction of the ePA in hospitals, as of the end of 2025.