Anestéziológia a intenzívna medicína 2/2018

Intensive care in the district hospital and its reimbursement in the DRG system

Intensive care is a demanding form of healthcare in terms of funding as well as the procedures that have to be carried out. 4% of beds dedicated to intensive care spend about 20-22% of total hospital costs. The range of provided healthcare and its quality depends on full reimbursement of all legitimate costs. The funding of standard healthcare in most European countries is based od DRG models. For the purpose of intensive care funding various scoring systems have been implemented, that rate the level of severity of the critical illness. The Slovak model (SK DRG) is derived from the German model (G DRG) in which the level of intensity of treatment is rated using the combined scoring system SAPS II- Core 10 TISS which identifies the units of intensive healthcare (PIM) of the third degree (The Anaesthesiology and Intensive Care Ward - OAIM) and the second degree (Intensive care unit – ICU). A prefered way of management of critical care in many European countries is to integrade the second and third degree critical care units into one unit of intensive care. In the Hospital of Revuca the OAIM and the surgical and the internal medicine ICU were integrated into one unit of intensive healthcare (PIM) with the capacity of 6 beds and non-stop service of qualified personnel. We evaluated the SAPS II-10 TISS score on the first day and the average score in 135 patients admitted to our united unit of intensive healthcare (PIM) during the period of 6 moths. The dividing line between the second and the third degree of intensive care oscillated around 40 points with the need of clinical correlation. The scoring system revealed that there had been patients with the need of the second degree critical care on OAIM as well as some of the patients requiring the highest level of critical care had been placed on ICUs. The scoring system which we used enables us to separate patients into stages of severity on one unit of intensive healthcare (PIM). We evaluated the real reimbursements, correlated them to average scores, compared them with calculated prices in the GROUPER (computer program) and counted the value of one point. The real reimbursements differed substantially from the GROUPER (computer program), mostly they were lower and in many cases lower then the fixed costs on PIM. Different point values did not corroborate the correlation of reimbursement and the severity level. Slovakia lacks standard definition of the second and the third degree of intensive care, the DRG-based payment system is disarranged and it conserves the current status. We suggest that the intensive care reimbursement is separated from the common healthcare funding, special calculated items are determined and the range of necessary procedures is defined. It is an essential requirement of intesive care reimbursement in objectively proven range and standard quality.

Keywords: integrated intensive care, intensive care reimbursement, combined scoring system SAPS II-Core 210 TISS