[Outpatient care in urology-an economic impact assessment].

Abstract

Background: The expansion of the AOP (ambulatory operation procedure) catalog according to § 115 b SGB V in the years 2023 and 2024, as well as the introduction of hybrid-DRGs (disease-related groups) according to § 115 f SGB V, poses significant planning challenges for clinics. These regulatory changes are accompanied by significant financial uncertainties for clinics, thus, necessitating careful planning. The need to treat patients in an outpatient setting forces hospitals to adjust their operational processes. The aim of this study is to analyze the impact on revenue in the urology department of a maximum care provider.

Methods: Data selection is made from the entire dataset of the urology department from the year 2023, including all procedures from the AOP catalog, applying context verification. From this, three risk groups (RG) are formed: 1) all cases that remain after context verification but still contain other procedures than only AOP procedures, 2) cases that contain only AOP procedures, and 3) a RG of the hybrid-DRG. An analysis of individual epidemiological parameters and a cost simulation were carried out.

Results: RG 1, with a share of 28.1% of the total number of cases, shows the greatest risk with 701 cases amounting to € 1,742,819 when treated in an outpatient setting. With 3.8%, RG 2 results in a significantly lower risk on revenue with 91 cases amounting to € 161,479 or € 106,071 after the cost-revenue simulation. RG 3 of the hybrid-DRG represents the lowest revenue risk with 24 cases amounting to € 10,880. The cost simulation shows a negative result for RG 3 accounting to € 18,925.

Conclusion: Transferring inpatient operations of urological patients to outpatient treatment is associated with a decline in revenue in urology. RG 2 and 3 show certainly calculable declines in revenue. Hospitals must analyze the loss of revenue and develop solution strategies.