title: [Otorhinolaryngology in the field of demography, growing outpatient care and regionalization].
abstract: BACKGROUND
  Otorhinolaryngology (ENT) departments are strongly affected by current changes in the reimbursement schemes for inpatients. The study was designed to investigate these effects on the ENT Department in Rostock and selected comparison clinics, as well as to outline solutions.
  
  
  METHODS
  We analyzed diagnosis-related group (DRG) reports of the ENT Clinic at Rostock University Medical Center from 2013 to 2015, according to the size of the outpatient potential. Comparisons were made with other surgical departments such as maxillofacial surgery and ophthalmology in terms of average length of stay and the resulting deductibles. We also compared billing as day surgery and complete outpatient surgery for the main small surgical procedures such as tonsillectomy and septum surgery. Finally, we compared the discounts with 22 ENT departments in other maximum care hospitals.
  
  
  RESULTS
  The average case mix index of an ENT department in Germany is 0.75, case load average of 2,500 patients and common length of stay 4.1 days. In a typical academic ENT department as in Rostock, health plans usually discount around 500 T€ (thousand euro), which is considerably higher than comparable departments, e.g., oral and maxillofacial surgery or ophthalmology departments. However, discounts on a DRG for inpatient surgery is still approximately 1,000 € more revenue than surgery in an outpatient setting. The benchmark analysis shows that health plans in rural areas are more likely to accept inpatient surgery with discounts for small procedures than strict billing according to outpatient reimbursement schemes.
  
  
  CONCLUSIONS
  These effects can result in an insufficient cost effectiveness of ENT departments in Germany. As a consequence, substantial restructuring of the in- and outpatient treatment seems necessary, also for academic ENT departments, e.g., in the form of day surgery or ambulatory surgical centers, outpatient clinics with special contracts and specialized inpatient surgery. However, this results in greater demands on the training of young physicians and management of patient flows within the department.
authors.affiliation: Universitätsmedizin Rostock, Ernst-Heydemann-Str. 8, 18057, Rostock, Deutschland. Christian.schmidt@med.uni-rostock.de.
authors.forename: C E
authors.initials: CE
authors.lastname: Schmidt
authors.affiliation: Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Schuldt
authors.affiliation: Lohfert und Lohfert AG, Hamburg, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Kaiser
authors.affiliation: Lohfert und Lohfert AG, Hamburg, Deutschland.
authors.forename: P
authors.initials: P
authors.lastname: Letzgus
authors.affiliation: Stabsstelle Betriebsorganisation, Innovations- und Qualitätsmanagement (BIQ), Medizinische Hochschule Hannover, MHH, Hannover, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Liebeneiner
authors.affiliation: Abteilung für Phoniatrie und Pädaudiologie, Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde/Chirurgie, Universitätsklinikum Bonn, Bonn, Deutschland.
authors.forename: K
authors.initials: K
authors.lastname: Schmidt
authors.affiliation: Abteilung für Kardiologie, Zentrum für Innere Medizin, Rostock, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Öner
authors.affiliation: Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie "Otto Körner", Universitätsmedizin Rostock, Rostock, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Mlynski
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis / Q000191:economics; D003710:Demography / Q000191:economics; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D010036:Otolaryngology / Q000191:economics* / Q000706:statistics & numerical data; D013517:Otorhinolaryngologic Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000191:economics* / Q000706:statistics & numerical data; D016526:Workload / Q000191:economics* / Q000706:statistics & numerical data
keywords: Ambulatory care; Day care, medical; Diagnosis-related groups; Organizational structure; Outpatients