Analysis and Assessment of Modifications of the PEPP System Introduced by the PEPP Catalogue 2015

Abstract

In 2015 the remuneration system for psychiatric and psychosomatic stationary treatments will be revised. The remuneration for a case is calculated by the product of base rate, a cost weight and the number of days of treatment. The cost weight varies depending on the number of days of treatment. This paper surveys the incentives, the casemix structure and the consistency of the modified PEPP system. Under the assumption of a profit-maximising supplier it is possible to define the economically optimal length of stay by comparing marginal revenues and marginal costs. Therefore a revenue function is derived from the new structure of the PEPP system. Since the determination of the marginal revenues is not mathematically possible, the revenues per additional day of treatment are calculated. On that basis it is possible to determine the economically optimal length of stay and to assess the consistency of the system changes. In an early stage of treatment the revenues per additional day of treatment are degressive. After a defined amount of days these additional revenues stay constant, which will be relevant for the majority of the cases. It is economically optimal for the hospitals to treat patients as long as possible, if the marginal costs lie or sink below these constant revenues per additional day of treatment. Furthermore the system changes result in a more complex casemix structure and the calculation of the cost weights is partially inconsistent, since the marginal revenues do not monotonically decrease. The modifications lead to a reduction of degressive elements in the PEPP system, which might also be accompanied by a decrease of economically induced pressure on length of stay. The inconsistent calculation of the cost weights and the more complicated casemix structure can be viewed critically.