Outpatient operations and ward replacement procedures in clinics are severely underfunded

30.11.2022 11:50

Outpatient operations and ward replacement procedures in hospitals are clearly deficient. On average, 34 percent of the costs incurred are not covered by the revenue. This shows an urgent need for action in the reimbursement structure in hospitals for services in accordance with Section 115b SGB V. This is the result of a study by the German Hospital Institute (DKI), which compares the costs and revenues for selected services.

For this purpose, the intervention with the most cases was selected from 14 service areas in the catalog for outpatient services (AOP). Nationwide, 45 hospitals provided cost and revenue data for around 18,500 cases (4 percent of hospitals that provide services in accordance with Section 115b SGB V).

As a result, the study finds that the structural framework conditions of outpatient operations in the hospital environment are not sufficiently taken into account by the applicable fee schedule (EBM) or by the current provisions of Section 115b SGB V specified in the AOP contract. These include, for example, significantly higher personnel costs in the hospital sector, completely different personnel qualifications in the outpatient hospital environment and inadequate reimbursement of material costs, which is also accompanied by a deductible that the hospitals have to bear independently. This means that the provision of outpatient services in hospitals is systematically disadvantaged.

“AOP services are not properly financed for hospitals. The uniform assessment standard is not suitable for remunerating these services for hospitals. It is urgently necessary to adequately reimburse outpatient operations and ward-replacing procedures in hospitals in order to sustainably support and accelerate outpatient care in hospitals,” explained the CEO of the German Hospital Association (DKG), Dr. Gerald Gass.