Fallpauschalen in der Krankenhaus-Psychiatrie der USA

Abstract

In Germany the introduction of a prospective payment system (PPS) is intended for inpatients hospitalised in psychiatric facilities. We investigate the various elements of the Prospective Payment System for Inpatient Psychiatric Facilities (IFP PPS) which was established in the USA in 2005 with respect to their potential to be incorporated into a german PPS. The most important elements of IFP PPS (impact of diagnosis, comorbidity, patient age, per diem adjustment for length of stay, various other adjustment factors like facility characteristics and geographical factors) are presented. The IFP PPS was especially designed for the requirements of psychiatric inpatient facilities in the USA. Complexity of the individual elements of the PPS appears to be manageable. However, various elements, e. g. the facility based adjustments including wage index or rural location and cost of living adjustments will not be applicable to countries other than the US. The 15 diagnosis related groups of the IFP PPS system refer to ICD-9 which is less differentiated than the ICD-10 which is in use in Germany, thus these psychiatric DRG will not be compatible under conditions of a german PPS. The per diem adjustment for length of stay is the predominating element of the IFP PPS, relation to effort/performance is insufficiently represented. Some elements of the IFP PPS may be applicable to a german prospective payment system for psychiatric inpatient facilities, especially with respect to the rules for per diem adjustment for length of stay and for handling of cases with frequent discharge and readmission of patients. Altogether a stronger representation of elements of performance of inpatient facilities seems to be desirable.