Henkelmann Jeanette, Henkelmann Ralf, von Dercks Nikolaus
Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig AöR, Liebigstraße 20, 04103, Leipzig, Deutschland.
Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland.
Unfallchirurgie (Heidelb). 2022 Sep;125(9):723-730. doi: 10.1007/s00113-021-01072-w. Epub 2021 Aug 31.
The act of the Medical Service of the Health Funds (MDK) is intended to shift health services previously provided in inpatient care to the outpatient care sector in accordance with § 115b SGB V. The aim of this study was the investigation of potential groups of inpatient cases of a university hospital for trauma surgery and orthopedics, which might be at risk for transfer to surgical outpatient treatment.
Data collection using SAP Data Warehouse included all inpatient cases 2017-2019, with subgroup analysis of economic parameters of three risk groups (RG): 1) primary misallocation, 2) procedures of AOP categories 1 and/or 2 and 3) elective 1‑day cases. Furthermore, an analysis of epidemiological parameters and an economic evaluation were performed.
Primary misallocations related to 245 cases, RG 2 had 764 cases and RG 3 had 891 cases. The average age was 45.5 ± 17.7 years and in 90% there were no relevant comorbidities (PCCL 0). The majority of cases were assigned to DRG I23B and I21Z (removal of osteosynthesis material, 15-23%), followed by open or arthroscopic surgery of the extremities (DRG I32F, I32G, I24Z, I18B, 6-9%). In cases of a statutory shift of inpatient to outpatient surgical procedures, the potential loss of revenue in 2017 was € 1,049,207, in 2018 € 1,076,727 and in 2019 € 923,163.
Individual groups have an increased potential in certain DRGs for a shift from inpatient to outpatient surgical procedures and are at risk for relevant revenue reductions in the course of further expansion of outpatient care. Proactive patient management in terms of outpatient versus inpatient treatment and special management of staff and spatial resources are necessary to anticipate potential downstream revenue cuts.
健康基金医疗服务（MDK）的行为旨在根据《社会法典第五卷》第115b条，将先前在住院治疗中提供的医疗服务转移到门诊护理部门。本研究的目的是调查一家大学创伤外科和骨科医院可能面临转移到外科门诊治疗风险的住院病例潜在群体。
使用SAP数据仓库进行数据收集，包括2017 - 2019年的所有住院病例，并对三个风险组（RG）的经济参数进行亚组分析：1）初次分配不当；2）AOP类别1和/或2以及3的手术；3）择期1天病例。此外，还进行了流行病学参数分析和经济评估。
初次分配不当涉及245例病例，风险组2有764例病例，风险组3有891例病例。平均年龄为45.5±17.7岁，90%的病例无相关合并症（PCCL 0）。大多数病例被分配到DRG I23B和I21Z（取出内固定材料，15 - 23%），其次是四肢的开放或关节镜手术（DRG I32F、I32G、I24Z、I18B，6 - 9%）。在住院手术向门诊手术法定转移的情况下，2017年潜在收入损失为1,049,207欧元，2018年为1,076,727欧元，2019年为923,163欧元。
某些DRG中的个别群体从住院手术向门诊手术转移的可能性增加，并且在门诊护理进一步扩大的过程中面临相关收入减少的风险。为了预测潜在的下游收入削减，需要在门诊与住院治疗方面进行积极的患者管理以及对人员和空间资源进行特殊管理。
