DGVP criticizes early dismissals
03.12.2009 15:10
Remuneration discounts for certified breast centers through MDK examinations
The Medical Service of the Health Insurance Funds (MDK) is apparently increasingly influencing certified breast centers to discharge patients following breast-conserving operations the day after the operation.
The citizens' initiative GesundheitDGVP eV received clear information about this. If this dismissal does not take place, the breast centers will subsequently be threatened with reductions in compensation when billing the health insurance company. The MDK justifies this with the assumption that gentle, modern breast cancer operations with preservation of the breast and limited radicality of the axillary operation do not require a longer period of post-operative lying down for operational reasons alone.
What is behind it: in the so-called DRG catalog (case flat rate catalog) invoice amounts are recorded for certain case constellations/treatments. There are also minimum stay periods. If this minimum stay is not met, i.e. the patient is discharged earlier than planned, this will result in bill deductions - the hospital will not receive the full billing amount provided for in the catalog for the case.
This regulation was originally introduced into the DRG system at the urging of health insurance companies in order to ensure this. To avoid “bloody discharge” from the clinics. Today, however, this regulation is being abused by the health insurance companies and the MDK commissioned by them: if the hospital sticks to the minimum length of stay, has provided all the required services and wants to bill the full amount for them, the health insurance company will pay it less using flimsy arguments. A breast center that adheres to the DRG catalog must therefore expect to receive less money - because it has thereby acted contrary to the new MDK justification for the shortened length of stay. However, this is only decided during the MDK examination and this takes place after treatment and the service provided.
President of the citizens' initiative GesundheitDGVP eV, Wolfram - Arnim Candidus, warns against possible premature obedience from hospitals due to the unjustified pressure exerted by the MDK. In any case, this is an attempt by the health insurance companies to save money and reduce costs, which is clearly at the expense of the patients.
The DGVP and its expert partners strongly reject this approach. The reasons lie in the severity of the disease and the not insignificant risk of subsequent bleeding. Therefore, treatment also includes continuous observation of wound healing beyond the first postoperative day.
Furthermore, outpatient care is unreasonable, especially for older patients, due to the usually longer journeys to the breast centers. In addition, the surgeon is responsible for checking the wound and not the respective patient's resident specialist or family doctor.
On the first postoperative day, all of the findings from the histopathological workup were still missing. In approximately 30% of all cases, a second procedure is necessary - this is one of the reasons why it is unrealistic for all patients to be discharged on the first postoperative day.
It is very important that the patients receive post-operative physiotherapy treatment with appropriate instructions in order to avoid or minimize complications. In addition to the surgical measure, primary therapy in accordance with the guidelines also requires postoperative radiotherapy, which must be explained to the patient and those they trust in detailed and repeated discussions. There is usually also a need for psycho-oncological support, which requires intensive medical care and cannot be completed on the first postoperative day.
The long-term intensive developments of guideline-compliant, multidisciplinary treatment must not be destroyed or sustainably negatively influenced by the arbitrary influences of the payers or the MDK.
The DGVP statement continues: “We defend ourselves against this influence in the interests of the patients and relatives, but also of the doctors and employees in the competence centers. Economization and radical cost pressures only lead to damage to healthcare provision.”