Klimke A, Godemann F, Hauth I, Deister A
Vitos Klinikum Hochtaunus, Emil-Sioli-Weg 1-3, 61381, Friedrichsdorf, Deutschland,
Nervenarzt. 2015 May;86(5):525-33. doi: 10.1007/s00115-015-4314-9.
The new German flat rate reimbursement system for psychiatry and psychosomatics (PEPP) is primarily based on the diagnostic classification and the costs of therapeutic processes. In 2019 the current normative standard for calculating the therapeutic staff in psychiatric clinics (Psych-PV) will be substituted by a stepwise adaptation process over 5 years. Using regionally calculated remuneration factors, all clinic budgets should eventually converge to comparable values.
Major factors influencing the structural quality of therapy in psychiatric clinics are identified and recommendations are given to support the work of the Federal Joint Committee (G-BA) which has been appointed to develop new recommendations for the minimum setting of personnel requirements.
The full reimbursement of the necessary staff and of the costs resulting from outsourcing of day clinics and outpatient departments in the community, including the obligation to treat psychiatric emergency patients is mandatory and currently not sufficiently guaranteed in the new PEPP system. A workflow which opens the possibility to finance therapeutic innovations (e.g. psychotherapy) and helps to overcome the financial sectorial boundaries between inpatient and outpatient treatment is also missing.
A mandatory recommendation for minimum staff settings needs a guaranteed full financing from the political side. Additionally, important would be an option for financing of therapeutic innovations and increased costs because of changed patient structures with respect to diagnosis and severity. Moreover, a sufficient remuneration for regional treatment responsibilities and for additional financial outlay resulting from structural costs for regionally outsourced departments is needed to avoid supplementary financing by reducing the budget for the therapeutic staff.
德国新的精神科和身心医学统一报销系统（PEPP）主要基于诊断分类和治疗过程的成本。2019年，目前用于计算精神病诊所治疗人员的规范标准（Psych-PV）将在5年内逐步被替代。利用区域计算的薪酬因素，所有诊所预算最终应趋于可比价值。
确定影响精神病诊所治疗结构质量的主要因素，并提出建议以支持联邦联合委员会（G-BA）的工作，该委员会已被任命为人员要求的最低设置制定新建议。
新的PEPP系统中，强制要求全额报销必要的工作人员以及日间诊所和社区门诊部外包产生的费用，包括治疗精神科急诊患者的义务，但目前这一点没有得到充分保障。此外，还缺少一种工作流程，该流程能够为治疗创新（如心理治疗）提供资金支持，并有助于打破住院治疗和门诊治疗之间的财务部门界限。
关于最低人员配置的强制性建议需要政治方面保证全额资金支持。此外，为治疗创新和因患者诊断及严重程度变化导致的成本增加提供资金的选择也很重要。此外，需要对区域治疗责任以及区域外包部门的结构成本产生的额外财务支出给予足够的报酬，以避免通过削减治疗人员预算来进行补充融资。
