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Philipps Universität Marburg Philipps Universität Marburg Fachbereich 20 – Medizin
Justus-Liebig-Universität Gießen Justus-Liebig-Universität Gießen Fachbereich 11 – Medizin
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2. Medical controlling

The economic counterpart to quality management is medical controlling. Medical controllers are internal advisers to physicians and the administration. In operative medical controlling, what are known as coding specialists identify and document services performed for each individual patient, while others have the task of checking the documentation. In this way they create the basis of correct accounting of services and a sound information basis for budget negotiations with payers.

To assist facilities, a reporting entity of the Medical Review Board of the Statutory Health Insurance Funds (MDK) was established. With the aid of this analysis tool, the areas of focus for controlling and the causes of controlling losses can be determined so as to develop measures to improve process and documentation quality. For 2015, the contractual parties face a major challenge with the Agreement on Review Procedures of the MDK. Basically, it is believed that this will speed up the review procedures, but that this will be accompanied by a considerable impairment of post- and re-codings in the review procedure and a rise in the number of social court cases with some payers.

Another component of medical controlling is documenting and recording highly complex nursing services (nursing complex procedure score, PKMS) in patient care, which was further improved and consolidated in 2015. The accounting-relevant requirements for nursing documentation were fulfilled without time-consuming multiple recording of data in the hospitals. Identifying patients requiring highly complex nursing and improving the documentation of the nursing services provided is an objective pursued by all our hospitals. For that purpose, the experts from the hospitals regularly engage in a mutual exchange in an expert working group. In addition, the switch to the system of flat-rate remuneration for psychiatric and psychosomatic facilities (FRPP) at psychiatric and psychosomatic acute hospitals will have an impact on the respective hospital’s results of operations. The switch to FRPP is mandatory as of 2017, but is budget-neutral until 2019. Currently, the hospitals are bringing their internal processes in line with these new challenges. We estimate that the effects on the results of operations will be minor in the short term. The medium-term assessment will depend on how the FRPP system develops.