Klimke A, Bader R, Berton R, Borrmann-Hassenbach M, Brobeil T, Nitschke R, Reitel G, Schillinger M, Godemann F
Vitos Hochtaunus, Vitos Waldkrankenhaus Köppern, Emil-Sioli-Weg 1-3, 61381, Friedrichsdorf, Deutschland,
Nervenarzt. 2014 Jan;85(1):88-95. doi: 10.1007/s00115-013-3981-7.
In Germany a new reimbursement system for psychiatry and psychosomatics is under development. Based on total costs of each case from selected hospitals and day clinics, in 2013 the Institute for the Hospital Remuneration System (InEK) proposed to reimburse the hospital costs daily with step-wise decreasing remuneration, mainly depending on the ICD-10 diagnosis, duration of stay and some complicating factors (PEPP grouper). It is controversial whether this degressive system will result in an inadequate remuneration of patients with longer duration of severe symptoms, such as suicidality in depression or autoaggressive behavior in borderline personality disorder and will eventually lead to advantages for acutely ill patients with short duration of stay compared to chronically ill patients.
This study formulated and tested an alternative remuneration system (proof of concept) mainly based on an analysis of daily cost data instead of the total costs of each case.
The study is based on 147,749 treatment days from 4,633 cases of patients with psychotic disorders (PEPP-PA03) in 6 hospitals. As possible cost separating factors the study analyzed days with and without intensive psychiatric care, 1 to 1 care, psychological diagnostics, magnetic resonance imaging (MRI), acute crisis intervention, age at admission, the first days of treatment and day of discharge.
Nearly all factors tested were shown to be statistically significant in separating daily hospital costs. Based on these findings an alternative calculation algorithm (TEPPconcret), which grouped the cases with respect to age, intensive care, 1 to 1 care, treatment days 1-4 and day of discharge, was formulated and tested. For psychotic disorders TEPPconcret with a basic rate complemented by daily add-on payments depending on the effort involved, is a serious alternative to the PEPP system and awaits further evaluation.
德国正在开发一种针对精神病学和身心医学的新报销系统。基于选定医院和日间诊所每个病例的总成本，2013年医院薪酬系统研究所（InEK）提议按日报销医院费用，薪酬逐步递减，主要取决于国际疾病分类第十版（ICD - 10）诊断、住院时间和一些复杂因素（PEPP分组器）。对于这种递减系统是否会导致严重症状持续时间较长的患者（如抑郁症中的自杀倾向或边缘型人格障碍中的自我攻击行为）报销不足，以及最终与慢性病患者相比是否会使住院时间短的急性病患者受益，存在争议。
本研究制定并测试了一种替代报销系统（概念验证），主要基于每日成本数据分析而非每个病例的总成本。
该研究基于6家医院4633例精神障碍患者（PEPP - PA03）的147749个治疗日。作为可能的成本分离因素，该研究分析了有无强化精神科护理、一对一护理、心理诊断、磁共振成像（MRI）、急性危机干预、入院年龄、治疗的头几天和出院日的天数。
几乎所有测试因素在分离每日医院成本方面均显示具有统计学意义。基于这些发现，制定并测试了一种替代计算算法（TEPPconcret），该算法根据年龄、重症监护、一对一护理、治疗第1 - 4天和出院日对病例进行分组。对于精神障碍，TEPPconcret以基本费率为基础，根据所涉及的工作量每日额外支付费用，是PEPP系统的一个重要替代方案，有待进一步评估。
