Flat rate remuneration system for psychiatry and psychosomatic medicine

The flat-rate pay system Psychiatry and Psychosomatics (PEPP) is an applied in Germany patient classification system based on a day-based costing in a clinically relevant and understandable manner, type and number of treated hospital admissions in relation to the resources of the hospital will set.

Legal basis

The fundamental decision to introduce a continuous, performance-oriented and flat-rate remuneration system on the basis of daily remuneration for full and part-time inpatient general hospital services by psychiatric and psychosomatic facilities was made by the legislature in 2009 with the creation of Section 17d of the Hospital Financing Act (KHG) through the Hospital Financing Reform Act . Thereafter, the Central Association of Health Insurance Funds and the Association of Private Health Insurances as well as the German Hospital Association were commissioned to introduce a remuneration system in accordance with the statutory requirements and to further develop and adapt it every year. At the end of 2009, a corresponding agreement on the introduction of a flat-rate remuneration system was concluded. However, the contracting parties were unable to agree on a remuneration system for 2013, so that, on the basis of a proposal by the Institute for the Hospital Remuneration System (InEK), the PEPP remuneration catalog and the associated accounting provisions for 2013 for opting institutions through replacement by the Federal Ministry of Health in Force were set.

Changeover to PEPP

Institutions of psychiatry and psychosomatic medicine , the new system can introduce on a voluntary basis from 2013 onwards. Originally, the application was supposed to be mandatory from 2015. With the "Law on the Further Development of the Financial Structure and Quality in Statutory Health Insurance" of July 24, 2014, the period in which clinics can voluntarily introduce the PEPP system has been extended by two years. From 2017 to 2019, the changeover will be budget-neutral. There is an adjustment to the previous hospital budget. The convergence phase begins in 2019. During this time, a state base fee is determined from the mean values of all InEK clinics (all costs of a treatment day for all treatment cases on average). By 2022, the previous hospital-specific value will be adjusted to the state base wage value.

Coding

With the introduction of the new accounting system, the job description of the medical coding specialist (MKF) is becoming increasingly important in the psychiatric sector.

Doctors and nursing staff in German clinics are increasingly dependent on the help of specially trained specialists due to the workload as well as the growing complexity and development of diagnosis-related case groups (DRGs - case flat rates), ICD (diagnosis catalog) and OPS (catalog of special psychiatric procedures).

This should ideally combine a combination of medical background knowledge, advanced knowledge of the PEPP system, business expertise and practice-oriented IT skills.

In order to meet the considerable billing and medical requirements, further training for medical professionals who have already been trained or suitable billing staff for MKF has been established. Here, graduates can acquire a certificate from the Chamber of Commerce and Industry as proof of qualification. A structured training standard has been established since 2013.

criticism

The planned introduction of the PEPP has led to massive protests from professional associations and unions, among others. Similar to the DRG system, the economic effects can hardly be assessed, but the incentives set should in any case lead to a serious deterioration in the care of mentally ill inpatients. But there are also peace signals for the introduction of PEPP. Above all, the severity of the illnesses must be shown in a more differentiated manner than before.

Criticism of criticism

However, the PEPP is advocated on the "Forced Psychiatry" website of the Federal Working Group on Psychiatry Experienced:

“It is a fairy tale, or rather an interest-based protective assertion, that more money for social education and therapeutic incantations would reduce psychiatric violence more and more. [...] This is proven by the so-called “dephospitalization”: Since the mid-70s, more and more money has been pumped into the psychiatric system. But instead of becoming fewer, there have been more and more forced admissions. "

- Forced psychiatry : Website of the Federal Working Group on Psychiatry Experienced

From this follows: According to the Federal Working Group, the situation will not get better with more money.

Individual evidence

↑ Institute for the Hospital Remuneration System (InEK), Flat-rate Remuneration System Psychiatry / Psychosomatics , Version 2013, Siegburg 2012, p. 1

↑ Law on the regulatory framework for hospital financing from 2009 (Hospital Financing Reform Act - KHRG) of March 17, 2009 ( Federal Law Gazette I p. 534 )

↑ Agreement on the introduction of a flat-rate remuneration system for psychiatric and psychosomatic facilities

↑ Ordinance on flat-rate fees for psychiatry and psychosomatic medicine 2013 (PEPPV 2013)

↑ Press release: Law on the further development of the financial structure and quality in statutory health insurance

↑ Do not introduce PEPP! Against the flat rate remuneration system for psychiatry and psychosomatic medicine (PEPP). Attac Germany.

^ Florian Staeck: Peace signals in the PEPP dispute. In: Ärztezeitung . June 25, 2013.