Ambulantisierungspotenzial stationärer Fälle einer universitären Klinik für Orthopädie und Unfallchirurgie

BACKGROUND: The act of the Medical Service of the Health Funds (MDK) is intended to shift health services previously provided in inpatient care to the outpatient care sector in accordance with § 115b SGB V. The aim of this study was the investigation of potential groups of inpatient cases of a university hospital for trauma surgery and orthopedics, which might be at risk for transfer to surgical outpatient treatment. METHODS: Data collection using SAP Data Warehouse included all inpatient cases 2017–2019, with subgroup analysis of economic parameters of three risk groups (RG): 1) primary misallocation, 2) procedures of AOP categories 1 and/or 2 and 3) elective 1‑day cases. Furthermore, an analysis of epidemiological parameters and an economic evaluation were performed. RESULTS: Primary misallocations related to 245 cases, RG 2 had 764 cases and RG 3 had 891 cases. The average age was 45.5 ± 17.7 years and in 90% there were no relevant comorbidities (PCCL 0). The majority of cases were assigned to DRG I23B and I21Z (removal of osteosynthesis material, 15–23%), followed by open or arthroscopic surgery of the extremities (DRG I32F, I32G, I24Z, I18B, 6–9%). In cases of a statutory shift of inpatient to outpatient surgical procedures, the potential loss of revenue in 2017 was € 1,049,207, in 2018 € 1,076,727 and in 2019 € 923,163. CONCLUSION: Individual groups have an increased potential in certain DRGs for a shift from inpatient to outpatient surgical procedures and are at risk for relevant revenue reductions in the course of further expansion of outpatient care. Proactive patient management in terms of outpatient versus inpatient treatment and special management of staff and spatial resources are necessary to anticipate potential downstream revenue cuts.