With the introduction of so-called “hybrid DRG” by the Ministry of Health, outpatient operations will now also be reimbursed with flat-rate treatment fees. The professional association for orthopedics and trauma surgery (BVOU), the professional association for arthroscopy (BVASK), the Society for Foot and Ankle Surgery eV (GFFC) and the DA-CH Association for Shoulder and Elbow Surgery (DVSE) warn that this means individual medicine more difficult and the quality of operations will decrease significantly. The cost pressure caused by flat-rate reimbursements leads to medically questionable decisions and ultimately to two-class medicine.
To date, materials and implants used or used during outpatient operations, such as bone plates, prostheses or anchors for attaching tendons, have been reimbursed individually by health insurance companies. The surgeon therefore makes the decision for the right implant without any cost pressure – exactly as the patient needs it.
In hospitals, these materials are financed through flat-rate costs (DRG). A current survey among doctors from BVOU, BVASK, GFFC and DVSE shows: The cost pressure caused by such flat-rate payments, as in the current inpatient DRG system, leads to medically questionable decisions. And this system should now also apply to outpatient operations!
In the survey, in which 600 surgeons responded, 60 percent of participants stated that if they were free to choose, they would make different decisions regarding the type and quantity of materials used during operations than under the current DRG conditions.
A fifth of the doctors even confirmed the statement that they were unable to treat patients under DRG conditions in accordance with scientific standards. Due to the cost pressure associated with implants and other medical materials, almost a third of those surveyed feel forced to split certain procedures into two operations, although from a medical perspective the entire procedure could also be carried out in a single operation.
Over 80 percent of surgeons are of the opinion that patients could receive better medical care if implants and other medical materials during operations were reimbursed based on consumption – as was previously the case with outpatient operations.
Many respondents took the opportunity to describe their concerns in free text: “worse patient care,” “cheap implants,” “end of operations in the outpatient sector,” “I no longer offer certain services,” “operations will no longer take place,” “worse quality of care”.
Health Minister Lauterbach actually comes to the same conclusion as the experts from orthopedics and trauma surgery. He also publicly complains about the over-economization and the false incentives introduced by the DRG system.
With the introduction of outpatient flat rates, he is now repeating the mistake a second time. The minister has also been complaining about the existence or threat of two-class medicine for years. However, with the introduction of the hybrid DRG, this will only be created for outpatient operations! Medically important decisions for those with statutory health insurance should now be made under cost pressure. Price dumping and loss of quality are inevitable.
The chairmen of the BVOU and BVASK, Dr. Burkhard Lembeck and Priv.-Doz. Dr. From this survey, Ralf Müller-Rath derives a clear demand from the Minister of Health: Special materials and implants must continue to be reimbursed separately by health insurance companies and based on actual consumption. This is the only way patients can be treated according to the disease and injury.
The Professional Association for Arthroscopy represents the professional and political interests of arthroscopic doctors (orthopedists and surgeons) in Germany. The goal is to be able to care for all patients using the most modern medical standards.
Contact
Professional Association for Arthroscopy
Kathrin Reisinger
Broad Street 96
41460 Neuss
02131-51257-22