A study funded by the Zi (Central Institute for Statutory Health Insurance) examines the outpatient treatment potential of acute care hospitals in Germany.
19.12.2023 15:04
At least 20 percent of all treatment cases in hospitals could potentially be performed on an outpatient basis. In 2021, more than 2.5 million inpatient procedures could have been performed on an outpatient basis. Otolaryngology (ENT), radiation oncology, and ophthalmology have the greatest potential for outpatient treatment.
Hospital care in Germany is characterized by an above-average bed capacity compared to other countries, as well as a high number of acute inpatient hospital treatments. While other European countries recorded an average of four hospital beds and 146 inpatient cases per 1,000 inhabitants in 2019, Germany, with six acute inpatient hospital beds and 252 cases, was significantly higher. Primarily due to the worsening shortage of skilled workers and sharply rising costs for hospital treatments, there is an increasing call to shift services currently provided on an inpatient basis to outpatient care. At the same time, the question of how high the potential for outpatient treatment actually is remains a subject of controversial debate.
2.5 million of the inpatient treatments could have been performed on an outpatient basis.
In 2021, more than 2.5 million inpatient treatments could have been performed on an outpatient basis. This represents almost one-fifth of all hospital treatments. Among the specialist departments, in addition to otolaryngology (ENT), radiation oncology and ophthalmology have the greatest potential for shifting inpatient treatments to outpatient settings. These are the key findings of the research project "Outpatient Potential in German Acute Care Hospitals," funded by the Central Institute for Statutory Health Insurance Physicians (Zi). The study was led by the Department of Healthcare Management at the Technical University of Berlin. The final report was published on December 18.
Investigation of the potential for outpatient care using two different methods
The study examined the potential for outpatient treatment using two different methods. The first was the context factor model proposed by the IGES Institute in its expert opinion on Section 115b of the German Social Code, Book V (SGB V). The second was a calculation based on the inclusions and context factors of the 2023 catalog "Outpatient Surgeries and Procedures Replacing Inpatient Care" (AOP Catalog). According to the IGES model, approximately 2.6 million inpatient treatments could have been performed on an outpatient basis in 2021, while the AOP Catalog indicated approximately 2.7 million. This corresponds to nearly 18 and 19 percent, respectively, of all inpatient treatment cases.
„The small overlap between the two approaches is striking. This shows that the two models predominantly identify different treatment cases as potentially suitable for outpatient care. The goal of the IGES model—to simplify the practice of inappropriate bed allocation checks in hospitals and to improve the distinction between services that necessarily require inpatient care and those that can be provided on an outpatient basis—has apparently not been fully achieved with the redesign of the 2023 outpatient procedure catalog,“ said study co-author Prof. Dr. Thomas Mansky.
Revision of the AOP catalog is required with regard to the services included and the context review.
To unlock the evidently high outpatient potential of services previously provided on an inpatient basis, a further revision of the outpatient surgery (AOP) catalog appears necessary with regard to the services included and the contextual assessment, affirmed Dr. Dominik von Stillfried, Chairman of the Board of the Central Institute for Statutory Health Insurance Physicians (Zi). "The 2023 AOP catalog falls significantly short of the potential identified in the IGES report with regard to the services included. A revision of the contextual factors also seems necessary because the AOP catalog is the essential basis for the further development of sector-specific reimbursement, which is intended to promote the shift towards outpatient care in Germany in the future. With a potential of up to four million cases, an increasing shift towards outpatient care of services previously provided on an inpatient basis appears urgently needed, given the financial and staffing challenges in inpatient hospital care, especially in light of international comparisons."„
The final report on the research project „Outpatient potential in German acute care hospitals“ is available. here Available for download.