B Bandelow1, U Lueken2, J Wolff3,4, F Godemann5, C Wolff-Menzler6,7, J Deckert2, A Ströhle8, M Beutel9, J Wiltink9, K Domschke2, M Berger4. 1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, 37099, Göttingen, Deutschland. Sekretariat.Bandelow@med.uni-goettingen.de. 2. Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland. 3. Abteilung für Betriebswirtschaft und Controlling, Universitätsklinikum Freiburg, Freiburg, Deutschland. 4. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Freiburg, Deutschland. 5. Klinik für Seelische Gesundheit im Alter und Verhaltensmedizin, Alexianer St. Joseph-Krankenhaus, Berlin-Weißensee, Deutschland. 6. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, 37099, Göttingen, Deutschland. 7. Alexianer Aachen GmbH, Alexianer Krankenhaus Aachen, Aachen, Deutschland. 8. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland. 9. Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Mainz, Mainz, Deutschland.
Abstract
BACKGROUND/ OBJECTIVES: The reimbursement of inpatient psychiatric psychotherapeutic/psychosomatic hospital treatment in Germany is regulated by the German personnel ordinance for psychiatric hospitals (Psych-PV), which has remained unchanged since 1991. The aim of this article was to estimate the personnel requirements for guideline-adherent psychiatric psychotherapeutic hospital treatment. METHODS: A normative concept for the required psychotherapeutic "dose" for anxiety disorders was determined based on a literature review. The required staffing contingent was compared to the resources provided by the Psych-PV based on category A1. RESULTS: According to the German policy guidelines for outpatient psychotherapy, a quota of 25 sessions of 50 min each (as a rule plus 5 probatory sessions) is reimbursed. This approach is supported by studies on dose-response relationships. As patients undergoing inpatient treatment for anxiety disorders are usually more severely ill than outpatients, a contingent of 30 sessions for the average treatment duration of 5 weeks seems appropriate in order to fully exploit the costly inpatient treatment time (300 min per patient and week). In contrast, only 70 min are reimbursed according to the Psych-PV. The total personnel requirement for the normative concept is 624 min per patient and week. The Psych-PV only covers 488 min (78 %). CONCLUSION: Currently, the time contingents for evidence-based psychiatric psychotherapeutic/psychosomatic hospital care are nowhere near sufficient. In the development of future reimbursement systems this needs to be corrected.
BACKGROUND/ OBJECTIVES: The reimbursement of inpatient psychiatric psychotherapeutic/psychosomatic hospital treatment in Germany is regulated by the German personnel ordinance for psychiatric hospitals (Psych-PV), which has remained unchanged since 1991. The aim of this article was to estimate the personnel requirements for guideline-adherent psychiatric psychotherapeutic hospital treatment. METHODS: A normative concept for the required psychotherapeutic "dose" for anxiety disorders was determined based on a literature review. The required staffing contingent was compared to the resources provided by the Psych-PV based on category A1. RESULTS: According to the German policy guidelines for outpatient psychotherapy, a quota of 25 sessions of 50 min each (as a rule plus 5 probatory sessions) is reimbursed. This approach is supported by studies on dose-response relationships. As patients undergoing inpatient treatment for anxiety disorders are usually more severely ill than outpatients, a contingent of 30 sessions for the average treatment duration of 5 weeks seems appropriate in order to fully exploit the costly inpatient treatment time (300 min per patient and week). In contrast, only 70 min are reimbursed according to the Psych-PV. The total personnel requirement for the normative concept is 624 min per patient and week. The Psych-PV only covers 488 min (78 %). CONCLUSION: Currently, the time contingents for evidence-based psychiatric psychotherapeutic/psychosomatic hospital care are nowhere near sufficient. In the development of future reimbursement systems this needs to be corrected.
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