Outpatient before inpatient—the good, the bad and the ugly

Abstract

Summary Background In January 2019 the Swiss Federal Department of Home Affairs defined a group of six selected surgical interventions to be performed on an outpatient basis. The aim of this paper is to assess surgeons’ opinions on patient safety, costs and treatment based on this new regulation. Methods An online survey was sent electronically to all 942 members of the Swiss Society of Surgery between August and October 2019. Results About half of the participants think the new regulation could harm patients (52%) and will lead to lower patient satisfaction (49%). Whereas half of the participants expect a reduction in health care costs (52%), most expect surgeons to earn less due to the new regulation (82%). About three quarters (73%) of the participants expect the new regulation to negatively affect surgical resident education. More than half (62%) of the participants assume that diagnoses allowing reimbursement for inpatient treatment (such as, e.g., bilateral instead of unilateral inguinal hernia) could be made more generously. Accordingly, 70% assume that the new regulation may result in not necessarily indispensable or possibly unnecessarily extended interventions (such as, e.g., bilateral inguinal hernia repair). Furthermore, most (86%) participants fear that the new regulation could possibly lead to hospitals/surgeons rejecting patients. Conclusion Whereas about half of the participants expect a reduction in health care costs, about two thirds fear that more generous diagnoses and not necessarily indispensable or possibly unnecessarily extended interventions could be performed due to the new regulation demanding outpatient care for said surgical interventions.

Inguinal hernia repair in inpatient children: a nationwide analysis of German administrative data

“…In addition, there is the problem of missing cost-effectiveness of hernia surgery per se [ 44 ], but in particular for ambulatory endoscopic surgery in which reimbursements do not cover the procedural costs [ 45 ]. It has thus been feared, based on a survey in Switzerland, which has a medical system broadly comparable to Germany, that upcoding may become an issue in using inpatient administrative data due to the resulting distortion [ 46 ]. However, a relevant shift of operations towards office-based surgeons is unlikely as the negative reimbursement differences are rather large in inguinal hernia surgery compared to other surgeries that could potentially be conducted office-based [ 47 ].…”