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Kostenträgerrechnungen von strabologischen Operationen an einer Universitäts-Augenklinik

BACKGROUND: Strabismus surgery is frequently carried out in university centers. The aim of this work was to calculate the costs of strabismus surgery at a university hospital and to assess the remuneration of costs for outpatient procedures. MATERIAL AND METHODS: Of all strabismus surgeries at the H...

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Autores principales: Framme, C., Gottschling, J., Kuiper, T., Lobbes, W., Palmaers, T., Brockmann, D., Lagrèze, W. A., Hufendiek, K.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Medizin 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508232/
https://www.ncbi.nlm.nih.gov/pubmed/32964287
http://dx.doi.org/10.1007/s00347-020-01227-x
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author Framme, C.
Gottschling, J.
Kuiper, T.
Lobbes, W.
Palmaers, T.
Brockmann, D.
Lagrèze, W. A.
Hufendiek, K.
author_facet Framme, C.
Gottschling, J.
Kuiper, T.
Lobbes, W.
Palmaers, T.
Brockmann, D.
Lagrèze, W. A.
Hufendiek, K.
author_sort Framme, C.
collection PubMed
description BACKGROUND: Strabismus surgery is frequently carried out in university centers. The aim of this work was to calculate the costs of strabismus surgery at a university hospital and to assess the remuneration of costs for outpatient procedures. MATERIAL AND METHODS: Of all strabismus surgeries at the Hanover Medical School in the years 2018 and 2019, relevant surgical data, such as patient age, number of muscles operated on, incision to suture time, attendance time of the surgeons and anesthetists as well as the nursing staff, were evaluated based on the clinics own information system. During this process, the costs for personnel, material, room rental charges and overheads were computed applying cost unit accounting. RESULTS: A total of 302 operations (inpatient proportion 92.1%) were carried out in most cases with the patient under general anesthesia. The mean patient age was 31 years (median 26 years), with 33 patients being children under 6 years of age. On average 1.84 muscles were treated per intervention. The mean incision to suture time was 51.5 min, mean anesthesia time was 85 min, the attendance time of surgical as well as anesthesia nursing staff each accounted for 104 min, the additional time in the postanesthesia care unit added 66 min. Average personnel costs originating from the overall process amounted to 642.14 €, with the addition of 109.23 € for material and medication (surgery and anesthesia) and costs for cleaning and room rental (including overheads) of 178.71 €. Therefore, the overall costs of an average strabismus surgery in our collective added up to 930.08 € (minimum 491.01 €, maximum 1729.29 €). Cost accounting of subgroups yielded substantially higher costs for anesthesia in children as well as for higher numbers of muscles operated on due to different treatment duration (37 min for 1 muscle to 72 min for 3 muscles) and anesthesia time, especially in children <6 years of age (on average 22 min longer than adults and children >5 years; the differences being 11 min for 1 muscle, 25 min for 2 muscles and 30 min for 3 or more muscles). The pure costs of a strabismus surgery at this clinic seem on average to exceed the revenues for strabismus surgery in the outpatient sector calculated by the German uniform evaluation benchmark (EBM) by about a factor of 2. CONCLUSION: It could be shown that the purely economically calculated costs for strabismus surgery at a university clinic are significantly higher than the revenues achieved in the outpatient sector according to paragraph 115b, section 1, of the Social Security Act V (SGB V). Under these circumstances, such operations cannot be performed in a cost-effective manner.
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spelling pubmed-75082322020-09-23 Kostenträgerrechnungen von strabologischen Operationen an einer Universitäts-Augenklinik Framme, C. Gottschling, J. Kuiper, T. Lobbes, W. Palmaers, T. Brockmann, D. Lagrèze, W. A. Hufendiek, K. Ophthalmologe Originalien BACKGROUND: Strabismus surgery is frequently carried out in university centers. The aim of this work was to calculate the costs of strabismus surgery at a university hospital and to assess the remuneration of costs for outpatient procedures. MATERIAL AND METHODS: Of all strabismus surgeries at the Hanover Medical School in the years 2018 and 2019, relevant surgical data, such as patient age, number of muscles operated on, incision to suture time, attendance time of the surgeons and anesthetists as well as the nursing staff, were evaluated based on the clinics own information system. During this process, the costs for personnel, material, room rental charges and overheads were computed applying cost unit accounting. RESULTS: A total of 302 operations (inpatient proportion 92.1%) were carried out in most cases with the patient under general anesthesia. The mean patient age was 31 years (median 26 years), with 33 patients being children under 6 years of age. On average 1.84 muscles were treated per intervention. The mean incision to suture time was 51.5 min, mean anesthesia time was 85 min, the attendance time of surgical as well as anesthesia nursing staff each accounted for 104 min, the additional time in the postanesthesia care unit added 66 min. Average personnel costs originating from the overall process amounted to 642.14 €, with the addition of 109.23 € for material and medication (surgery and anesthesia) and costs for cleaning and room rental (including overheads) of 178.71 €. Therefore, the overall costs of an average strabismus surgery in our collective added up to 930.08 € (minimum 491.01 €, maximum 1729.29 €). Cost accounting of subgroups yielded substantially higher costs for anesthesia in children as well as for higher numbers of muscles operated on due to different treatment duration (37 min for 1 muscle to 72 min for 3 muscles) and anesthesia time, especially in children <6 years of age (on average 22 min longer than adults and children >5 years; the differences being 11 min for 1 muscle, 25 min for 2 muscles and 30 min for 3 or more muscles). The pure costs of a strabismus surgery at this clinic seem on average to exceed the revenues for strabismus surgery in the outpatient sector calculated by the German uniform evaluation benchmark (EBM) by about a factor of 2. CONCLUSION: It could be shown that the purely economically calculated costs for strabismus surgery at a university clinic are significantly higher than the revenues achieved in the outpatient sector according to paragraph 115b, section 1, of the Social Security Act V (SGB V). Under these circumstances, such operations cannot be performed in a cost-effective manner. Springer Medizin 2020-09-22 2020 /pmc/articles/PMC7508232/ /pubmed/32964287 http://dx.doi.org/10.1007/s00347-020-01227-x Text en © The Author(s) 2020 Open Access. Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden. Die in diesem Artikel enthaltenen Bilder und sonstiges Drittmaterial unterliegen ebenfalls der genannten Creative Commons Lizenz, sofern sich aus der Abbildungslegende nichts anderes ergibt. Sofern das betreffende Material nicht unter der genannten Creative Commons Lizenz steht und die betreffende Handlung nicht nach gesetzlichen Vorschriften erlaubt ist, ist für die oben aufgeführten Weiterverwendungen des Materials die Einwilligung des jeweiligen Rechteinhabers einzuholen. Weitere Details zur Lizenz entnehmen Sie bitte der Lizenzinformation auf http://creativecommons.org/licenses/by/4.0/deed.de.
spellingShingle Originalien
Framme, C.
Gottschling, J.
Kuiper, T.
Lobbes, W.
Palmaers, T.
Brockmann, D.
Lagrèze, W. A.
Hufendiek, K.
Kostenträgerrechnungen von strabologischen Operationen an einer Universitäts-Augenklinik
title Kostenträgerrechnungen von strabologischen Operationen an einer Universitäts-Augenklinik
title_full Kostenträgerrechnungen von strabologischen Operationen an einer Universitäts-Augenklinik
title_fullStr Kostenträgerrechnungen von strabologischen Operationen an einer Universitäts-Augenklinik
title_full_unstemmed Kostenträgerrechnungen von strabologischen Operationen an einer Universitäts-Augenklinik
title_short Kostenträgerrechnungen von strabologischen Operationen an einer Universitäts-Augenklinik
title_sort kostenträgerrechnungen von strabologischen operationen an einer universitäts-augenklinik
topic Originalien
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508232/
https://www.ncbi.nlm.nih.gov/pubmed/32964287
http://dx.doi.org/10.1007/s00347-020-01227-x
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