Rathmayer Markus, Heinlein Wolfgang, Wagner Tobias, Lerch Markus M, Lammert Frank, Dollhopf Markus, Haag Cornelie, Gölder Stefan Karl, Kandulski Arne, Schad Moritz, Schmidt Alexandra, Gundling Felix, Wilke Michael, Albert Jörg G
inspiring-health GmbH, Munich, Germany.
Klinikum der Ludwigs-Maximilian-Universität München, Munich, Germany.
Z Gastroenterol. 2023 May;61(5):504-514. doi: 10.1055/a-2016-9196. Epub 2023 Mar 9.
The transfer of patient care and medical interventions that was previously provided on an inpatient basis to outpatient settings is a stated goal of health politics. It is unclear to what extent costs of an endoscopic procedure and the disease severity depend on the duration of inpatient treatment. We therefore examined whether endoscopic services for cases with a one-day length of stay (VWD) are comparably expensive to cases with a longer VWD.
Outpatient services were selected from the DGVS service catalog. Day cases with exactly one such gastroenterological endoscopic (GAEN) service were compared with cases with VWD>1 day regarding their patient clinical complexity levels (PCCL) and mean costs. Data from the DGVS-DRG project with §21-KHEntgG cost data from a total of 57 hospitals from 2018 and 2019 served as the basis. Endoscopic costs were taken from cost center group 8 of the InEK cost matrix and plausibility checked.
A total of 122,514 cases with exactly one GAEN service were identified. Statistically equal costs were shown in 30 of 47 service groups. In 10 groups, the cost difference was not relevant (<10%). Cost differences >10% existed only for EGD with variceal therapy, insertion of a self-expanding prosthesis, dilatation/bougienage/exchange with PTC/PTCD in place, non-extensive ERCP, endoscopic ultrasound in the upper gastrointestinal tract, and colonoscopy with submucosal or full thickness resection, or foreign object removal. PCCL differed in all but one group.
Gastroenterology endoscopy services provided as part of inpatient care but potentially performable on an outpatient basis are predominantly equally expensive for day cases as for patients with a length of stay greater than one day. The disease severity is lower. Calculated §21-KHEntgG cost data thus form a reliable basis for the calculation of appropriate reimbursement for hospital services to be provided as outpatient services under the AOP in the future.
将以前在住院基础上提供的患者护理和医疗干预转移到门诊环境是卫生政策的既定目标。目前尚不清楚内镜手术的成本和疾病严重程度在多大程度上取决于住院治疗的持续时间。因此，我们研究了住院时间为一天（VWD）的病例的内镜服务是否与住院时间较长的病例同样昂贵。
从德国胃肠病学和内镜外科学会（DGVS）服务目录中选择门诊服务。将恰好接受一项此类胃肠内镜（GAEN）服务的日间手术病例与住院时间>1天的病例在患者临床复杂程度（PCCL）和平均成本方面进行比较。来自DGVS-DRG项目的数据以及2018年和2019年来自57家医院的§21-KHEntgG成本数据作为基础。内镜成本取自InEK成本矩阵的成本中心组8并进行了合理性检查。
共识别出122514例恰好接受一项GAEN服务的病例。47个服务组中的30个显示出统计学上相等的成本。在10个组中，成本差异不显著（<10%）。仅在伴有静脉曲张治疗的上消化道内镜检查、置入自膨式假体、在有经皮肝穿刺胆管造影术（PTC）/经皮肝穿刺胆管引流术（PTCD）的情况下进行扩张/探条扩张/置换、非广泛的内镜逆行胰胆管造影术（ERCP）、上消化道内镜超声检查以及伴有黏膜下或全层切除或异物取出的结肠镜检查中存在>10%的成本差异。除一组外，所有组的PCCL均有所不同。
作为住院护理一部分但可能在门诊进行的胃肠内镜服务，对于日间手术病例和住院时间大于一天的患者来说，成本主要是相同的。疾病严重程度较低。因此，计算得出的§21-KHEntgG成本数据为未来根据门诊协定计划作为门诊服务提供的医院服务的适当报销计算提供了可靠依据。
