Julian Schwarz1, Martin Heinze2, Martin Holzke3, Andreas Klär4, Michael Löhr5,6, Reinhard Schaffert7, Jan Wolff8,9. 1. Hochschulklinik für Psychiatrie und Psychotherapie der Medizinischen Hochschule Brandenburg, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Deutschland. julian.schwarz@mhb-fontane.de. 2. Hochschulklinik für Psychiatrie und Psychotherapie der Medizinischen Hochschule Brandenburg, Immanuel Klinik Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Deutschland. 3. Klinik für Psychiatrie und Psychotherapie Weissenau, ZfP Südwürttemberg, Weingartshofer Straße 2, 88214, Ravensburg, Deutschland. 4. Jüdisches Krankenhaus Berlin, Heinz-Galinski-Str. 1, 13347, Berlin, Deutschland. 5. Klinik für Psychiatrie und Psychotherapie, Geriatrie und Neurologie, LWL Klinikum, Buxelstraße 50, 33334, Gütersloh, Deutschland. 6. Fachhochschule der Diakonie, Bielefeld, Deutschland. 7. Klinikverbund Hessen e. V., Forsthausstr. 1-3, Haus 3e, 35578, Wetzlar, Deutschland. 8. Peter L. Reichertz Institut für Medizinische Informatik der TU Braunschweig und der Medizinischen Hochschule Hannover, Mühlenpfordtstraße 23, 38106, Braunschweig, Deutschland. 9. Evangelische Stiftung Neuerkerode, Braunschweig, Deutschland.
Abstract
BACKGROUND: Nursing staff were excluded from the German DRG system for somatic hospital treatment and will be funded separately in the future. In psychiatry and psychosomatic medicine, binding personnel requirements have been defined but there has been no regulation of how these personnel requirements are adequately financed. OBJECTIVE: The objective of this study was to analyze the costs of inpatient psychiatry and psychosomatic medicine and to evaluate possible effects of funding nursing staff separately. MATERIAL AND METHODS: This analysis is based on aggregated daily treatment costs of selected hospitals (data year 2018), which annually submit their performance and cost data to the Institute for the Hospital Remuneration System (InEK) for the empirical further development of the remuneration system. RESULTS: Nursing staff represent the largest cost factor in inpatient psychiatry and psychosomatic medicine. Excluding nursing staff drastically reduces the variance of psychiatric DRG renumeration and even exceeds its proportion of the total costs. After outsourcing nursing costs, psychiatric DRGs achieve only a very limited cost separation. CONCLUSION: The binding personnel requirements necessitate adequate financing of nursing staff. This raises the debate about the further development of psychiatric remuneration. The question arises as to whether the effort associated with using the psychiatric DRG system justifies its usefulness as an instrument for budgeting when core functions such as cost separation are only given to a limited extent. Alternative approaches to budgeting should also be examined for putting costs and benefits in a better ratio.
BACKGROUND: Nursing staff were excluded from the German DRG system for somatic hospital treatment and will be funded separately in the future. In psychiatry and psychosomatic medicine, binding personnel requirements have been defined but there has been no regulation of how these personnel requirements are adequately financed. OBJECTIVE: The objective of this study was to analyze the costs of inpatient psychiatry and psychosomatic medicine and to evaluate possible effects of funding nursing staff separately. MATERIAL AND METHODS: This analysis is based on aggregated daily treatment costs of selected hospitals (data year 2018), which annually submit their performance and cost data to the Institute for the Hospital Remuneration System (InEK) for the empirical further development of the remuneration system. RESULTS: Nursing staff represent the largest cost factor in inpatient psychiatry and psychosomatic medicine. Excluding nursing staff drastically reduces the variance of psychiatric DRG renumeration and even exceeds its proportion of the total costs. After outsourcing nursing costs, psychiatric DRGs achieve only a very limited cost separation. CONCLUSION: The binding personnel requirements necessitate adequate financing of nursing staff. This raises the debate about the further development of psychiatric remuneration. The question arises as to whether the effort associated with using the psychiatric DRG system justifies its usefulness as an instrument for budgeting when core functions such as cost separation are only given to a limited extent. Alternative approaches to budgeting should also be examined for putting costs and benefits in a better ratio.
Authors: André Nienaber; Michael Schulz; Rüdiger Noelle; Hauke Felix Wiegand; Claus Wolff-Menzler; Sibylle Häfner; Florian Seemüller; Frank Godemann; Michael Löhr Journal: Psychiatr Prax Date: 2015-02-02
Authors: E Swart; E M Bitzer; H Gothe; M Harling; F Hoffmann; D Horenkamp-Sonntag; B Maier; S March; T Petzold; R Röhrig; A Rommel; T Schink; C Wagner; S Wobbe; J Schmitt Journal: Gesundheitswesen Date: 2016-06-28