title: Interdisciplinary pain therapy: an innovative therapeutic but pre-DRG Economical Center of Medical Excellence.
abstract: OBJECTIVE
  After the implementation of the G-DRG system in Germany, doubts arose whether and how interdisciplinary pain therapy centers should be restructured to remain profitable and maintain medical excellence for patients with a long ordeal of malaise.
  
  
  METHODS
  To reveal structural deficits, we performed a detailed economic analysis of all patients treated at an interdisciplinary pain therapy center of a German University hospital in 2004.
  
  
  RESULTS
  3,672 patients were treated: 2,163 outpatients, 753 at the daycare clinic, 619 as consults and 132 inpatients. The costs for personnel were euro 736,645, consumables euro 105,061, and infrastructure euro 277,762. We calculated fixed costs of euro 236, and consumables of euro 24 per patient. The costs for surgery were euro 1,595, and for a neuroradiological examination euro 245 per patient. Overall treatment costs were euro 319 per patient. We calculated an overall loss of euro 476,752 or euro 109.19 per patient. Outpatients caused a total loss of euro 456,665.83 or euro 211 per patient, consults a total loss of euro 161 683.16 or euro 261.20 per patient, daycare patients a slight profit of euro 30,370 or euro 40 per patient and inpatients a total profit of euro 111,225 or euro 135 per day.
  
  
  CONCLUSIONS
  Managerial optimization can yield considerable cost reductions in the G-DRG coding system, without any change in treatment strategies, selection of profitable patients or dismissal of personnel. Inversely, additional personnel are needed to accomplish the implementation process. Board certification was unveiled to constitute the key structural implementation that ensures the economic survival of the department and continuing medical excellence for the patients.
authors: Department of Neurosurgery, University of Freiburg Medical School, Freiburg, Germany. deining@nz.ukl.uni-freiburg.de
authors: M H
authors: MH
authors: Deininger
authors: T
authors: T
authors: Wolter
authors: A
authors: A
authors: Weyerbrock
authors: A
authors: A
authors: Greulich
authors: A J
authors: AJ
authors: Goldschmidt