Vergütung intensivmedizinischer Leistungen im DRG-System

Abstract

The reimbursement of intensive care and nursing services in the German health system is based on the diagnosis-related groups (G-DRG) system. Due to the lack of a central hospital planning, the G‑DRG system has become the most important influence on the development of the German health system. Compared to other countries, intensive care in Germany is characterized by a high number of intensive care beds, a low nurse-to-patient ratio, no official definition of the level of care, and a minimal available data set from intensive care units (ICUs). Under the given circumstances, a shortage of qualified intensive care nurses and physicians is currently the largest threat for intensive care in Germany. To address these deficiencies, we suggest the following measures: (1) Integration of ICUs into the levels of care which are currently developed for emergency centers at hospitals. (2) Mandatory collection of structured data sets from all ICUs including quality criteria. (3) A reform of intensive care and nursing reimbursement under consideration of adequate staffing in the individual ICU. (4) Actions to improve ICU staffing and qualification.

The future development of intensive care quality indicators – a methods paper

“…In addition to these methodological requirements, fundamental quality dimensions such as safety, effectiveness, patient focus, timeliness, efficiency and equity should be considered as important focal points [ 17 ]. The importance of QI in quality assurance has already been mentioned, as well as the potential for the unwelcome instrumentalization of the DIVI QI for reimbursement schemes in the DRG system (definition of intensive care treatment complexity), among other things [ 7 ]. This goes beyond a strictly medical evaluation of processes in intensive care and needs to be addressed with improved methodological quality in their development.…”

“…At present, the recording of intensive care QI is voluntary, either through voluntary peer review or through institutional quality management. However, the importance of these QI is increasing, as they have already impacted structural directives for intensive care medicine, as can be seen from their influence on intensive care reimbursement rules [ 7 ]. The demand for “evidence-based medicine” as a basis for the correct implementation of treatment processes made the development of the DIVI QI in their revisions increasingly labor-intensive, as the indicators were predominantly process indicators for which the underlying evidence frequently changes; and thus updates are required [ 8 ].…”

Diskussionspapier für eine Reform der Krankenhausfinanzierung in Deutschland aus der Perspektive der Intensivmedizin

“…Fünfundzwanzig Jahre nach der Abkehr vom Selbstkostendeckungsprinzip und 15 Jahre nach Einführung des auf Diagnosis-Related-Groups (DRG) basierenden Fallpauschalensystems als zentralem Element der Krankenhausfinanzierung in Deutschland wird von vielen Seiten eine grundlegende Reform der Krankenhausfinanzierung gefordert [1][2][3]. Hauptkritikpunkte sind die negativen Auswirkungen der zwischenzeitlich eingetretenen Ausrichtung medizinischer Behandlungen an betriebswirtschaftlichen Organisationsprinzipien mit einer im internationalen Vergleich auffallend hohen Steigerung an stationären Behandlungsfällen, der Orientierung der Vergütung der Leistungen auf Basis durchschnittlicher Krankenhausbehandlungskosten ohne Berücksichtigung infrastruktureller Besonderheiten sowie der u. a. durch die unzureichende Refinanzierung tariflicher Entwicklungen ausgelöste Personalmangel, insbesondere in der Pflege.…”

Leih- und Zeitarbeit in der Intensivpflege

“…Auf der Ausgabenseite sind die Personalkosten der größte Kostenfaktor im Krankenhaus. Im Gegensatz zu den ärztlichen Leistungen werden die pflegerischen Leistungen im deutschen DRG-System nur unzureichend auf der Erlösseite abgebildet [4]. Hieraus begründet wurden vor allem im pflegerischen Bereich in den letzten Jahren massive Personaleinsparungen getätigt.…”