At the end of September 2022, the hospital commission suggested introducing flat day rates (German: “Tagespauschalen”) for hospital day treatments.
Driven by the staff shortage in hospitals, this idea was further developed by Karl Lauterbach and the German Ministry of Health. On 7 Nov 2022, they published the first draft of the new law on inpatient day treatments.
Proposed day treatments in hospital
According to Karl Lauterbach, hospital day treatment should already become a reality in Germany in January 2023.
The change is targeted at treatments or service offerings that currently are inpatient procedures taking at least 6 hours. However, instead of spending the whole time at the hospital, patients will be discharged after the procedure and can spend the night at home, if they agree. The goal is to relieve the nursing and care staff and to save money for the healthcare system at the same time.
As a caveat though, the hospital will be liable for any complications from the discharge. Therefore, hospitals must ensure there are sufficient clinicians, nursing staff and beds in place to address potential complications. In the event of an unfavourable outcome, they need to immediately convert the day treatment into an overnight treatment.
Types of procedures considered for hospital day treatments
It is not yet known whether there will be a list of procedures and treatments that could be considered for flat day rates. The hospital commission estimated that overall about 25% of all inpatient treatments might be eligible.
It will be decided on a case-by-case basis, particularly based on medical aspects and the individual home care situation, whether a hospital day treatment is an option.
Treatments NOT eligible to become day treatments are:
- Large, complex or high-risk treatments
- Ambulatory (outpatient) treatments, e.g. those listed in the AOB catalogue
- One-day treatments without admission and treatment at the emergency unit
- Treatments provided by not-hospital-employed clinicians (German: “Belegarzt”)
- Treatments of patients who receive home care
Reimbursement of day treatments
The flat rate for these day treatments should be based on the DRG. This means the same payment amount is calculated for every patient with the same diagnosis. For those patients who are discharged, the flat rate will be reduced to reflect the savings on accommodation costs. This is estimated at about €140-150 per night. However, this reduction can’t exceed 30% of the total costs.
For services that were provided and reimbursed as inpatient procedures so far, a standardized payment across both inpatient and outpatient care sectors will be introduced in January 2023. The GKV-SV, PKV, DKG and KBV are meant to monitor the payment system and report by April 2024 on the extent and consequences.
Next steps
The legal basis for this will be covered in section 39 paragraph 1 SGB V, and the new section 115e SGB V.
The exact definition of German “hospital day treatment” needs to be included in the catalogue of hospital treatments. “Day treatments” will be added to the existing treatment categories: fully inpatient, partly inpatients, hospital-equivalent, and outpatient care.
Patients will be entitled to day treatments alongside the full inpatient treatment option.
This should ensure that there is a strict separation between partly-inpatient care and the better-paid day treatment.
A key aim is to ensure the documentation requirements and increased complexity of billing do not counterbalance the planned relief for hospital staff.
Critique on proposal
The Bavarian health minister, Klaus Holetschek, criticised the plans and proposed to use health centres with overnight accommodation instead.
He is questioning
- “What kind of treatment could be day treatments if the patient is so ill that he has to be treated in the hospital, but then can be discharged to go home overnight?
- Who monitors the health of patients at home at night?”
The German Patient Protection Foundation also has raised some concerns about the plans. Instead of the plan, they suggest tailoring the inpatient care to various patient groups, expanding the offer in rural areas, and reducing “the oversupply in the metropolitan areas”.
The GKV-SV also sees a risk that patients might be discharged, not based on strict criteria, but for profitability reasons.
Further reading related to hospital care
- How much does a certain treatment cost in Germany? – What you need to know
- Happy with your knowledge on the reimbursement of medical devices in Germany?
- First study to show that G-DRG system has causal effects on patient care
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