Special facility

from Wikipedia, the free encyclopedia

Special facilities are hospitals , physically separate departments of hospitals or specialist hospitals that cannot be properly remunerated with the DRG flat-rate catalog due to an accumulation of seriously ill patients or for medical reasons of the supply structure .

Admission process

The self-administration in the health care system , the health insurances - both statutory and private - negotiate with the German Hospital Association, as the umbrella organization of the hospital owners, who is approved as a special facility and which medical indications are based, partly at the ICD level. In the special facilities, patients receive appropriate, long-term medical care from multi-professional teams that is tailored to their personal needs. There are also successful petitions from patients and hospital staff against underfunding through case-based lump sums.

financing

The special facilities are temporarily removed from the DRG remuneration system in accordance with Section 17b (1) sentence 15 KHG (every year). Since health insurance companies are only allowed to have hospital treatment provided by approved hospitals (Section 108 SGB V), one of the three following regulations is required:

1. The special facility is recognized as a university clinic according to state law, 2. The special facility is included as a hospital in the hospital plan of a state (plan hospital) or 3. The special facility has a supply contract with the state associations of health insurance companies and the associations of the substitute funds.

Established medical indications

history

After the provisions on special facilities for the years 2004 and 2005 were determined by means of substitute performance by ordinance by the Federal Ministry of Health, the self-governing partners were able to reach an agreement for the years 2006 to 2018 via negotiation (Agreement on the determination of special facilities - VBE) .

Extension: In addition to editorial adjustments, the VBE 2016 implemented the changes to Section 17b (1) sentence 15 of the KHG, in particular through the Hospice and Palliative Care Act (HPG). Since the HPG came into force on December 8, 2015, this date is also the date of the VBE 2016 agreement.

Tiered system of emergency structures in hospitals

The G-BA has to define minimum requirements for each level of inpatient emergency care, in particular to

  • the type and number of specialist departments,
  • the number and qualifications of the specialist staff to be provided and
  • the temporal scope of the provision of emergency services

to be differentiated. The regulations of the G-BA also take into account special emergency care offers such as emergency care for children, care for the seriously injured in trauma centers, care for strokes and care for circulatory disorders in the heart. In addition, the hospital planning authorities of the federal states have the option in special cases - for example in the case of regional characteristics - to designate other hospitals as special providers. These receive the status of special facilities and take part in emergency care on a budget-neutral basis.

Updated contract dated December 3, 2018 for 2019

The contracting parties have agreed to update the VBE 2018 for 2019 and only adapt it editorially. The VBE from 2017 were updated in 2018.

Further development of the special facilities

  • The GKV-Spitzenverband, Berlin and
  • the Association of Private Health Insurance, Cologne
- together -
agree with the
  • German Hospital Society, Berlin

(1) In order to support the appropriate further development of the DRG remuneration system at the federal level, the health insurance companies that are contracting parties according to Section 11 of the Hospital Remuneration Act for a particular institution, immediately after the corresponding budget agreement, transmit the following information to the DRG institute of self-administration partners according to Section 17b para. 2 of the Hospital Financing Act:

  1. the negotiation documents to be submitted in accordance with Section 6, Paragraph 3, Clauses 3 and 4 of the Hospital Remuneration Act in conjunction with Section 17, Paragraph 4 of the Federal Care Rate Ordinance in the version applicable on December 31,
  2. a description of the facility according to structural features, care mandate, the patients to be treated and a reason for the exception from the DRG reimbursement system,
  3. proof of the special nature of the facility according to § 2,
  4. Type, amount and number of the agreed fees and
  5. due to which, significantly higher costs, the performance of the device with the proceeds sum of the DRGs, the additional revenues for long lying patients and patients and additional charges are not compensated properly. At the same time, the hospital transmits the data records to the DRG Institute in accordance with Section 21 of the Hospital Remuneration Act for the hospital and, in the case of Section 1 (3) to (5), separately for the special facility, unless it is exempt from delivery in accordance with (2) sentence 2.

Web links

Individual evidence

  1. ↑ Legal regulation
  2. ↑ UK Tübingen
  3. ↑ New regulation of the emergency structures in German hospitals. G-BA § 136c Abs. 4 SGB V - April 19, 2018.
  4. ↑ dkgev.de: Inpatient hospital financing - VBE 2019
  5. ↑ VBE 2018 web link to the contract on the website of the National Association of Statutory Health Insurance Funds