[Realisation of material costs in anaesthesia. Alternatives to the reimbursement via diagnosis-related groups].
OBJECTIVE
For reimbursement via diagnosis-related groups (DRG), lump compensation-based payment of medical cases in German hospitals requires a case-related measuring and billing of resources that has to be consistent with DRG guidelines. Only through this, can the real costs be compared with the standard costs as calculated by the hospital reimbursment system (InEK) on a case-related basis and the DRG-specific break-even level be identified.


METHODS
In the present paper the authors introduce and validate two newly created alternative methods for case-related allocation of material costs in the field of anaesthesia. Method 1 allows online documentation of material costs via pre-defined anaesthesia standards. This full cost method is suitable for hospitals that have implemented an electronic hospital information system in their daily clinical documentation routine. For other hospitals method 2 could be applicable as the case-related allocation of material costs is done retrospectively based on the data collected in an electronic anaesthesia protocol record system (andoc, medlinq).


RESULTS
Method 1 makes it possible to allocate 90.3% of anaesthesia-related material costs to a specific case corresponding to a Pearsson coefficient of 0.77. After iterative improvement through optimisation of modules the documentation quality could be raised to >98% and a Pearsson coefficient of 0.96. Although the expense for implementation and maintenance is considerable, the necessary documentation work for the clinician is low. Method 2 demands no further clinical effort in documentation and implementation and 49.1% of all material costs can be assigned on a case-related basis.


CONCLUSIONS
The online documentation of material costs via predefined anaesthesia standards accounts for nearly all material costs in anaesthesia and only a negligible documentation effort is necessary for the clinician. Nevertheless, a complex and time-consuming configuration of standards and a continuous iterative alignment of the modules with the actual processes are required. Due to its process-orientated character, method 1 can also be used for workflow optimisation in terms of standard operating procedures (SOPs). Allocation of material costs with data from the electronic anaesthesia record system is a method that can be easily implemented but only a partial case relation is rendered possible.
Meyer-Jark
Ties
T
Klinik für Anästhesie und Intensivmedizin, Schlei-Klinikum Schleswig MLK, Lutherstrasse 20, 24837 Schleswig. meyer-jark@gmx.de
Reissmann
H
H
Schuster
M
M
Raetzell
M
M
Rösler
L
L
Petersen
F
F
Liedtke
S
S
Steinfath
M
M
Bein
B
B
Scholz
J
J
Bauer
M
M
D000758:Anesthesia / Q000191:economics* / Q000592:standards; D003365:Costs and Cost Analysis; D003953:Diagnosis-Related Groups; D004469:Economics, Hospital; D006801:Humans; D016347:Medical Records Systems, Computerized; D015233:Models, Statistical; D009862:Online Systems; D012051:Reimbursement Mechanisms