Doktorarbeit: Verbesserung der Qualität der Kostenkalkulation in der gastroenterologischen Endoskopie

Verbesserung der Qualität der Kostenkalkulation in der gastroenterologischen Endoskopie

Aufbau von Methodik und IT-Werkzeugen für einen Leistungs- und Kostenbenchmark sowie Entwicklung und Validierung eines Leistungskatalogs zur Kostenverteilung

Gesundheitsmanagement und Medizinökonomie, volume 54

Hamburg , 198 pages

ISBN 978-3-339-12396-1 (print)
ISBN 978-3-339-12397-8 (eBook)

about this book

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To assess the cost of endoscopic procedures 74 hospitals, annual providers of cost-data to the Institute for the Hospital Remuneration System (InEK), made their data (2011 – 2015; § 21 KHEntgG) available to the German Society of Gastroenterology (DGVS) in anonymized form (4873 809 case-datasets). Using cases with exactly one endoscopic procedure (n = 274 186) average costs over 5 years were calculated for 46 endoscopic procedure-tiers. For 46 endoscopic procedure-tiers an objective cost-allocation within the G-DRG system is now possible.

The German hospital reimbursement system (G-DRG) is incomplete for endoscopic interventions and fails to differentiate between complex and simple procedures. This is caused by outdated methods of personnel-cost allocation.

To establish an up-to-date service catalogue the delivered patient and cost datasets were used to classify operation-and-procedure codes (OPS) into procedure-tiers (e. g. colonoscopy with biopsy/colonoscopy with stent-insertion). An expert panel ranked these tiers according to complexity and assigned estimates of physician time. In 2014 exact time tracking data for a total 38.288 individual procedures were collected in 119 hospitals to validate this service catalogue.

In this three-step process a catalogue of 97 procedure-tiers was established that covers 99 % of endoscopic interventions performed in German hospitals and assigned validated mean personnel-costs using gastroscopy as standard. Previously, diagnostic colonoscopy had a relative personnel-cost value of 1.13 (compared to gastroscopy 1.0) and rose to 2.16, whereas diagnostic ERCP increased from 1.7 to 3.62, more appropriately reflecting complexity. Complex procedures previously not catalogued were now included (e. g. gastric endoscopic submucosal dissection: 16.74).

In addition, a unique data pool has emerged from this project, which provides both medical and economic data from over 70 hospitals over a period of nine years, based on the § 21-KHEntgG data set. This has provided the basis for various other research questions on health care in Germany. Various papers also on non-endoscopic topics have already taken this up.

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