Psychiatric outpatient department
A psychiatric institute outpatient clinic (PIA) is a multi-professional outpatient treatment offer of psychiatric specialist hospitals and psychiatric departments at general hospitals, which are authorized to participate in statutory medical care in accordance with Section 118, Book V of the Social Code (SGB V) . Section 118 (previously in Section 368n (6) 2 RVO ) was added in 1986 with the law to improve outpatient and inpatient care for the mentally ill (PsychKVVerbG).
These are outpatient hospital services . Also, university hospitals and clinics for child and adolescent psychiatry able to offer these services. Since 2000, not only psychiatric specialist clinics, but also psychiatric departments in general hospitals have been authorized. The target groups (type, severity or duration of the illness) are to be defined in a contractual solution by the top organs of self-administration. For the psychiatric departments, a nationwide agreement on Section 118 (2) SGB V between the National Association of Statutory Health Insurance Physicians, the Central Association of Statutory Health Insurance Funds and the German Hospital Society has been in force since 2001. It regulates details about target groups, access and range of services. Since 2013, the legislature has also provided for the authorization of psychosomatic outpatient departments. There is still no nationwide framework agreement on this. The authorization created by law for geriatric outpatient clinics in 2015 in accordance with Section 118a of Book V of the Social Code only enables diagnostics (assessment) and therapy planning to be offered; the facilities can only be active on referral.
The remuneration takes place outside of the total remuneration of the contract doctor directly by the health insurances and is agreed at the level of the federal states. There are considerable differences between the countries. In most cases, flat rates per case are agreed for each billing quarter. In Bavaria there is a separate regulation for the remuneration of individual services. PIAs were set up at 448 clinics nationwide in 2014. For 2014, statistics from the InEK Institute for the remuneration system in hospitals showed a total performance of around 2.3 million treatment cases in Germany. Insured persons receive an average of 3.3 treatment appointments per billing case and quarter, of which around 12% are outreach services, for example home visits.
The main focus of care is the treatment of seriously and chronically ill patients in the context of aftercare, but also emergency psychiatry. The aim is to avoid or shorten inpatient treatments, but also to ensure treatment for patients who are not or not sufficiently achieved by the offers of general practitioners. The care concept is practically an integrated form of care, but is not fixed or limited to specific diagnoses . Further developments are technical specializations and the adaptation to regional needs as well as the development of offers in psychosomatic medicine. Discussions about the form of billing in the future flat-rate remuneration system for psychiatry and psychosomatics PEPP are ongoing. The professional tasks of the PIA have been advised in a working group of psychiatric specialist hospitals and departments since 1990.
literature
- Andreas Spengler (Ed.): Institute outpatient departments in psychiatric care. Vandenhoeck & Ruprecht, Göttingen 1991, ISBN 3-525-45738-3 .
- Andreas Spengler : Psychiatric institute outpatient clinics. Efficient, needs-based and innovative. Deutsches Ärzteblatt 109 (40), A 1981-1983.
- Volker Dahling: Care of home residents by a psychiatric institute outpatient clinic. In: Journal for Gerontopsychology & Psychiatry. Vol. 22, No. 23/2009, pp. 67-80.
- Margitta Köster: Psychiatric institute outpatient clinics in Baden-Württemberg. Univ.Diss. Tübingen 2005. (pdf; 1.1 MB)
- Heidi Durst: organizational structure and conception of a psychiatric institute outpatient clinic (PIA). GRIN Verlag, 2010, ISBN 978-3-640-75458-8 . (E-book)
- Joachim Hübner, Federal Working Group of Psychiatric Hospitals: The Role of Institute Outpatient Clinics in the Psychiatric Care System (pdf)