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Norbert Roeder

Publications and source records attributed to Norbert Roeder.

16 recordsLinked to original sources
PubMed2006

[Evaluation of flat-rate payment in radiation oncology. German experience with disease-related groups for inpatient funding in radiation oncology].

PURPOSE: In Germany a new casemix-related reimbursement system with "diagnosis related groups" (DRGs) for inpatient treatment was started in 2003. The first German system G-DRG 1.0 was developed on the basis of the Australian AR-DRG version 4.1. German inpatient treatment in radiation oncology was not specifically represented in this system due to the very different health care systems. As the DRG system was planned as a pricing system with severe effects on the funding of radiation oncology departments, an adjustment was urgently needed. For the modification, national data about pattern of care and economic relevance were needed. METHODS: For 3,689 cases treated in radiation oncology departments from eleven hospitals data were collected prospectively concerning diagnosis, length of stay, procedures and high-cost drugs and treatments. The DRGs were analyzed for homogeneity in length of stay and costs. Readmission frequency and interval were analyzed and the relevance of existing reimbursement regulations for this situation was evaluated. RESULTS: It could be shown, that radiation therapy implicated additional expenses for oncologic inpatients. These additional costs were not represented in the G-DRG 1.0 reimbursement system. Chemotherapy was an additional cause for economically inhomogeneous oncologic DRGs. The complex sequence of cases for the same patient could be shown, and that the rules for reimbursement of readmissions have to take these sequential treatments into account. Based on these data, modifications of the reimbursement system were suggested. In the following G-DRG version for the year 2004, 21 DRGs were designed for patients receiving radiation therapy. The regulations concerning the readmission of oncologic patients were modified. The correlation between the number of radiation therapy fractions and the total expense was acknowledged in the following year (G-DRG system 2005) and resulted in 35 DRGs. The version for 2006 showed the solidity of these solutions with almost unchanged definitions of these DRGs. CONCLUSION: This evaluation revealed the deficits in the G-DRG system 1.0 (and the AR-DRG system 4.1) related to the inpatient treatment in radiation oncology departments. Modifications could be proposed for following years. In 2004-2006, the regulatory boards adopted several implications of these data for the improvement of the German casemix-based hospital-financing system.

Diagnosis-Related Groups↗
PubMed2005

[G-dRG version 2005: relevant aspects for dermatology].

One year after the obligatory implementation of a new hospital funding system based on Diagnosis Related Groups (DRG) the third version of a German DRG-system has been published. It differs significantly from the previous version. Modifications in the classification system and the introduction of further procedure-based payments contribute to a better depiction of specialized clinical services. A number of acknowledged problems which caused great discussion in 2004 have been solved, yielding a more appropriate mapping of clinical services. The algorithms of the major diagnostic categories have been modified and complications, comorbidities and/or multiple procedures will be considered more precisely in selecting a group. However, some inconsistencies concerning highly specialized medical procedures and special features of impatient dermatological care remain. Nevertheless, a great improvement over the previous versions is apparent. The crucial aspects of the G-DRG version 2005 and the accompanying rules and regulations of payment are reviewed in detail with special relevance to dermatology.

Algorithms↗
PubMed2005

Pathway management in ambulatory wound care: defining local standards for quality improvement and interprofessional care.

Growing health care costs and changes in health care delivery, such as the adoption of the diagnosis-related groups, have tremendously affected treatment patterns all over the world. Pathway management is suitable to be responsive to the growing operating requirements and to manage effective and efficient medical care in hospitals. Pathways standardise clinical processes for patients with a similar diagnosis, procedure or symptom thereby optimising the quality of treatment and patient satisfaction. They are utilised by a multidisciplinary team with a primary focus on quality and coordination of care. Considering the key strategies of pathway management, an interprofessional team containing physicians and nurses developed and implemented a clinical pathway for ambulatory treatment of chronic wounds. A precise medical protocol was created to standardise routine procedures, to improve the treatment outcome and to provide an integrated documentation that enhances interprofessional collaboration. We designed a modular concept of four different sheets which provide pre-defined standards: (a) medical admission, (b) findings and history, (c) topic and systemic treatment and (d) evaluation of outcome criteria. Variances must be merely written down in detail. After 1 year in clinical practice, we state that the use of a clinical pathway for chronic wound management is an effective method of improving clinical processes and patient outcomes.

Ambulatory Care↗
PubMed2005

[Introduction of quality management with the EFQM Self-Assessment method. Implementation and experience in a university department of dermatology].

In the near future, the German legislative and health insurance agencies will increasingly demand proof of quality in hospital health care. The role of quality management in hospitals is emphasized by the introduction of per-case payment (DRG) in Germany. The implementation of internal quality management at an early stage sets the course of a systematic and continuous quality improvement process, with the goal to increase performance and results by efficient utilization of resources. The decision for or against one or another quality management model appears to be difficult, since the possible impacts of the quality management system can hardly be foreseen. As this article shows, the Self-Assessment method of the European Foundation for Quality Management (EFQM) provides a valuable and efficient tool to introduce quality management in a hospital environment. The Self-Assessment method enables a systematic survey of levels of performance and outcome of the hospital. Furthermore, it provides an appropriate basis to identify areas of strengths and weaknesses. A high degree of motivation of the personnel is fostered by the creation of a local guidance circle, a coordinating group, and several Self-Assessment teams. However, formulation and deployment of improvement actions are necessary for the long-term implementation of quality management. The application of Self-Assessment in quality management appears a suitable tool to promote excellence.

Dermatology↗
PubMed2004

[DRGs in dermatology: results of the DRG evaluation project of the German Society of Dermatology (DDG)].

SUMMARY BACKGROUND: The implementation of a DRG system in Germany--voluntarily since January 1st, 2003, and obligatory after January 1 st, 2004--has led to uncertainty, particularly in the hospitals. There are fears that current well-accepted German diagnostic and therapeutic services may not be properly financed by the new system. In response, the German Dermatologic Society (DDG) in cooperation with the DRG Research Group of the University Hospital Muenster and the German Medical Association carried out a DRG evaluation project in order to investigate the medical and economic homogeneity of the case groups. PATIENTS AND METHODS: 19,403 dermatological cases from 19 hospitals--ten university hospitals and nine non-university hospitals-were collected over a period of four months and then evaluated with regard to their performance, length of stay and cost homogeneity. RESULTS: The data provided the background needed to indicate suspected potential deficiencies for mapping dermatology cases within the German DRG system. Based on the data 10 modifications were formulated and submitted to the InEK by the deadline of March 31st, 2003. CONCLUSIONS: The results of the DRG Evaluation Project show that the G-DRG-Variant Version 1.0 does not offer the necessary possibilities of differentiation to map the broad spectrum of various dermatology services in Germany.

Cost-Benefit Analysis↗
PubMed2004

[G-DRG Version 2004: changes in view of dermatology].

In the year 2004 the obligatory introduction of the new hospital funding system based on a Diagnosis Related Groups (DRG) system will become reality for all German hospitals. After all fundamental items of the new G-DRG version were made generally known, the possible consequences had to be considered. The first mandatory German case-based lump sum catalogue differs importantly from the previous payment models and requires intensive study. Economic considerations will increasingly play a role in the daily routine of hospitals and influence treatment patterns. Therefore, comprehensive knowledge of basic principles of G-DRG is essential. In the following aspects of the reimbursement system with special relevance to dermatology are reviewed in detail. Additionally, the revised classification system versions OPS-301 SGB V and ICD-10-GM 2004 and the German coding standards version 2004 must be appropriately applied for dermatologic purposes.

Dermatology↗
PubMed2004

[Comorbidity of mental disorders in the German G-DRG system -- effect on length of stay and revenue at a university hospital].

OBJECTIVES: The effect of comorbid mental disorders on the length of stay and revenue in a DRG system was investigated. METHODS: For 33,189 cases of an university hospital (year 2002) the revenue based on a fictitious base rate was calculated, at first with and then without inclusion of diagnosed comorbid mental disorders. Furthermore, the effect of the latter on the length of stay was examined. RESULTS: Renunciation of diagnoses of mental disorders lead to an different DRG grouping in 7.9 % of cases and to a reduction in revenues of about 170.000. Minimal influence of comorbid mental disorders on the length of stay (R2 = 0.02) could be detected for single diagnostic groups. CONCLUSIONS: The lacking influence of comorbid mental disorders on the length of stay in a university hospital is mainly determined by the limited period of inpatient treatment and by the low frequency of diagnosed mental disorders. Therefore, a psychosocial consultation-liaison service is of major importance to guarantee the diagnosis and treatment of a comorbid mental (process quality) disorder and to guarantee adequate revenues in the G-DRG system (quality of structure).

Adult↗
PubMed2003

The diagnosis related groups enhanced electronic medical record.

PROBLEM: The introduction of Diagnosis Related Groups as a basis for hospital payment in Germany announced essential changes in the hospital reimbursement practice. A hospital's economical survival will depend vitally on the accuracy and completeness of the documentation of DRG relevant data like diagnosis and procedure codes. In order to enhance physicians' coding compliance, an easy-to-use interface integrating coding tasks seamlessly into clinical routine had to be developed. A generic approach should access coding and clinical guidelines from different information sources. METHODS: Within the Electronic Medical Record (EMR) a user interface ('DRG Control Center') for all DRG relevant clinical and administrative data has been built. A comprehensive DRG-related web site gives online access to DRG grouping software and an electronic coding expert. Both components are linked together using an application supporting bi-directional communication. Other web based services like a guideline search engine can be integrated as well. RESULTS: With the proposed method, the clinician gains quick access to context sensitive clinical guidelines for appropriate treatment of his/her patient and administrative guidelines for the adequate coding of the diagnoses and procedures. This paper describes the design and current implementation and discusses our experiences.

Diagnosis-Related Groups↗
PubMed2003

[Analysing strengths and weaknesses: opportunities and threats for service providers in the German health care system].

Hospitals in the German health care system are confronted with increasing economic competition due to paradigm shifts in funding inpatient treatment. Major hospitals, such as university hospitals, will be under significantly greater pressure to keep up the ability to compete by uniform per case payment. The new hospital funding system based on a Diagnosis Related Group (DRG) system and the economic competition involved require analyses of organisational and locational factors. Cooperativeness and efficient utilisation of resources, properties and staff will be determining factors to secure existence. Adequate responses and strategies are essential to cope with the growing operating requirements. Carrying out an analysis identifying one's own strengths and weaknesses, opportunities and threats will help to focus activities and sustainable strategies into areas where the strengths and the greatest opportunities lie. An example of the process of strategic planning and positioning is shown for a university department of dermatology.

Delivery of Health Care↗
PubMed2003

[DRGs in dermatology: quality of coding and the effects of case mix].

BACKGROUND: High-quality coding of patient clinical data is mandatory for an effective DRG classification to result in adequate allocation of funding for inpatient treatment. The aim of the study was to determine the effect of controlled documentation on patient clinical data and to ascertain the outcome of calculated DRG-based yields depending on higher coding quality of patient treatment. PATIENTS AND METHODS: In a prospective study, 1914 patient clinical records from the Department of Dermatology, University of Muenster, were captured using different documentation standards and the data was analysed. Grouping was performed on the basis of the Australian Refined DRG system v4.1. Dermatological patients were broken down into eleven groups based on principle diagnosis. RESULTS: As a result of a controlled documentation, case mix, case mix index and patient clinical complexity level (PCCL) value were increased within identical samples. Furthermore, it was shown that high-quality coding may result in exact and reasonable classification of patient clinical data. CONCLUSIONS: Different documentation standards may cause undesired effects on the monetary yields of in-patient treatment. It appears that high-quality coding and controlled documentation may guarantee adequate yields. FauIty. incomplete and (up)coding could be a potential economic risk for hospitals.

Dermatology↗
PubMed2002

[The DRG law--planning gone wrong? The conversion from the physician's point of view].

With the Health Care Reform Act of 2000 the German government initiated the introduction of a new hospital funding system based on an internationally used Diagnosis Related Group (DRG) system. In June 2000, the medical self-governing bodies (consisting of representatives of the German Hospital Federation, the German Statutory Health Insurance Funds and the Association of Private Health Insurances) commissioned for the execution of this project decided to use the Australian Refined DRG system, version 4.1 (AR DRG) as the basis for the future German (Refined) DRG system (G-DRG). It is planned for voluntary hospitals to replace the previous German hospital reimbursement system by the new DRG-based hospital funding system in January 2003. From January 2004, the change of the reimbursement system will be mandatory for all hospitals with the exception of psychiatric, psychosomatic and psychotherapeutic hospitals or units. The new reimbursement system is not only intended to cover acute hospital care but also parts of early rehabilitation, palliative and sub-acute care. Due to its economic incentives the effects of introducing the DRG system in Germany will not only affect the hospital sector but ambulatory care, nursing and rehabilitation as well.

Australia↗