Length of stay

The term of stay ( or stay) is needed in health care. It specifies the time that is hospitalized in a hospital, a patient. The definition of the residence time in accordance with § 1 para 7 Regulation on the DRG system for hospitals ( KFPV ) is decisive ... is the number of days stayed. Occupancy are the days of admission and every other day of hospitalization without the laying or discharge day ...; is a patient or a patient recorded on the same day and transferred or dismissed, this day is considered as admission.

Therefore counted the presence of 24 clock. Example: Recording Monday, dismissal Friday, length of stay of 4 days. The residence time can be added as an average for all countries, for departments and for specific diagnoses.

Background

In Germany, the residence has a significant financial impact on hospitals. The usual pre-2004 accounts on a daily rate with longer hospital stays led to an increase in revenue. In the wake of health care reform was aimed to prevent such medically unnecessary hospitalizations and change which came into force in March 2002 Act on the Introduction of diagnosis-related billing system according to DRGs for hospital services.

The case reimbursement means that for certain diagnoses (see ICD -10) and procedures (see OPS), hospitals can bill a fixed amount at the payers. This was introduced with the GMG for health insurance. The binding since 1 January 2004 (DRGs ) replaced the hitherto used for billing daily rates. Thus, the notion of length of stay has been introduced. In contrast to the previous billing form, the cost of a hospital increase at a settlement by case flat with the same revenue more so the longer a patient stays in the hospital. Therefore, there is an economic incentive to dismiss patients as early as possible to your home or in the outpatient follow-up treatment for the hospitals.

The coated dwell therefore depends on the group of cases in which a patient was classified. Determining factors for the case group are asked the principal diagnosis, possible secondary diagnoses, the procedures performed and other event -related criteria.

In Germany, the average length of stay in 2003 was 8.9 days, while it is 6.1 days average in the EU. A further reduction in the length of stay in Germany is not excluded.

Maximum length of stay

Differences are an upper and lower limit of stay. The upper trim point determines up to which length of stay in the hospital the standard fee applies. If this period is exceeded in individual cases, a dependent of the additional residence time compensation is paid by the payers. Whether these cover the corresponding additional costs, depending on the individual case.

Analog does the logic of the lower trim point: If the patient is hospitalized below this limit, occurs a reduction of the DRG fee. Thus, the lower cost and lower cost for the patient is taken into account.

International Overview of the residence

The OECD has published 2007 statistics on the average length of stay in acute care. In Japan it is 19.8 days in Germany 8.6, Switzerland 8.5 days. Other countries: Czech Republic 8, Slovak Republic and Luxembourg 7.3, Portugal 7.1, Netherlands 6.8 Ireland 6.6, Poland 6.5, Hungary 6.3, UK 6.1, Austria 5.9, USA 5.6, Iceland and France 5.4, Norway 5.2 Finland 4.8 Sweden 4.6, Denmark 3.5 Mexico and 4. The average of these countries is 6.8 days. From the following OECD countries no data were available: Australia, Belgium, Greece, Italy, Canada, South Korea, New Zealand, Spain and Turkey.

Criticism of the length of stay reduction

An early discharge of patients from the hospital for economic reasons is referred to by critics as " Bloody dismissal ". Early dismissals entail some risks for the patients but also cost risks for the cost objects, such as when because of illness increased outpatient hospital care, home health care, or even a renewed inpatient hospitalization are needed ( "revolving door " effect ).

From office-based physicians criticism is that they have to bear the economic risk of layoffs, because the outpatient treatments are expensive and complex by the unfinished healing without that they can be fully charged at the payers.

Avoidance strategies

To avoid " bloody layoffs ", was regulated in the settlement process with the hospitals, the maximum length of stay. Particularly short hospital stays have therefore discounts or a specially calculated Fallpauschale, especially long stays surcharges on the Fallpauschale result. There are also deadlines after discharge from the hospital, which exclude the case of a renewed hospitalization the settlement of a new flat rate per case. However, this only applies if certain criteria of DRG agreement ( FPV) are met. The legislature has determined b the Hospital Funding Act in § 17, the need to submit an accompanying research by the end of 2005. The contract for this was given in May 2008 by notice in the Official Journal of the European Union in order.