Federal Council calls for further development of the flat rate per case system

20.12.2021 12:28

The federal states are striving to further develop the reimbursement system for treatment in hospitals. The Federal Council passed a corresponding resolution in its plenary session on December 17, 2021 at the initiative of Lower Saxony, Bremen, Mecklenburg-Western Pomerania and Rhineland-Palatinate.

Fair refinancing of holding costs

In particular, he calls on the federal government to further develop the current system through legislative initiatives in order to reflect the different cost structures to which individual hospitals are subject, for example. B. as a basic, standard or maximum provider. This is the only way to fairly refinance the different maintenance costs in the individual facilities. Since 2004, acute inpatient somatic treatments in hospitals have been reimbursed via a nationwide uniform flat rate catalog (diagnosis-related groups, or DRGs for short). The DRG catalog currently includes a total of 1,292 DRGs.

Danger to basic services

However, the application of this per-case flat-rate system, which is based on average costs, leads to inadequate coverage of basic care services such as gynecology/obstetrics and pediatrics in the hospital sector, warns the state chamber. As a result, these service offerings would decrease among service providers for economic reasons; Easily accessible care is therefore at risk.

The undesirable development must be counteracted by changing the legal framework, as the largely flat-rate DRG system creates incentives to expand services. The aim must be a remuneration structure that removes the service providers from this cycle and enables facility-oriented and treatment-necessary reimbursement of costs.

The federal government should develop the complex DRG system, which causes considerable bureaucratic costs on both the hospital and the statutory health insurance side, into an effective billing system that creates more resources for the care of patients.
Retention flat rates

The Federal Council expressly calls for a system of retention allowances independent of revenue. In addition, the states should be closely involved in the upcoming discussions of the planned government commission for the further development of hospital financing.

The resolution was forwarded to the federal government. It decides when to address the states' concerns. There are no fixed deadlines for this.