HNU Healthcare Management Insights #23

There have been political calls for the outpatient treatment of surgical cases in Germany for many years. In your opinion, what are the main reasons why implementation has been so slow?

Jascha Rinke: The reasons are manifold and interwoven. On the one hand, the structures in many hospitals are still heavily geared towards inpatient treatment, and the necessary restructuring requires investment in processes and infrastructure. On the other hand, there is a lack of standardized regulations and financial incentives to facilitate the transition to outpatient surgery settings.

However, the remuneration structure is a key stumbling block. Inpatient procedures are economically more attractive, which motivates hospitals to prefer inpatient billing. This leads to a dilemma that we call the AOP dilemma: Currently, there are only a few, often unattractively remunerated outpatient cases left, which alone are not sufficient to operate an independent outpatient surgery center in an economically viable manner. This area of conflict is blocking change, although the healthcare system urgently needs relief through more efficient processes.

You often talk about the so-called AOP dilemma. What exactly do you mean by this, and how does it affect outpatient care?

Jascha Rinke: The AOP dilemma describes the contradictory situation in which hospitals are trying to expand the outpatient sector, but at the same time have to stick to inpatient structures. Inpatient procedures are often much more attractive economically, which encourages hospitals to continue to prefer them.

Outpatient surgery, on the other hand, is often unattractive under the current remuneration structure. In many cases, the necessary outpatient infrastructure is not developed because it is associated with investment costs and economic risks. This dilemma is exacerbated by political uncertainty: there is a lack of clear framework conditions and long-term stable remuneration models, making many facilities reluctant to invest in the outpatient sector.

This creates a vicious circle in which outpatient care is slowed down considerably despite political will and procedural advantages. This conflict between the expectations of progress and the real hurdles is blocking the urgently needed transformation.

Do you have a solution to this dilemma? How could outpatient treatment be promoted?

Jascha Rinke: I see a promising solution in an elective surgery center (EOP) that combines outpatients and scheduled inpatients in a short-track concept. This model not only offers considerable savings potential in terms of occupancy days, but also increases the efficiency of processes. Inpatients, like outpatients, are admitted to the EOP on the day of surgery and are only transferred to the ward after the operation (same-day surgery principle). This eliminates unnecessary pre-admission stays and frees up valuable capacity on the wards, resulting in significant potential savings.

In addition, the EOP concept remains flexible, as it can be adapted to both outpatient and inpatient requirements and can react to future developments. The model is not only suitable for new buildings, but can also be easily integrated into existing hospital infrastructures, given the right conditions.

Another advantage of this approach is the increase in process and resource efficiency. Hospitals can optimize their processes by treating both outpatients and inpatients in an integrated concept, which leads to better capacity utilization and a reduction in idle times. This model enables gradual, adaptable outpatientization that meets the various requirements and developments in the healthcare sector.

You talk about potential savings through the reduction of occupancy days - can you give a concrete estimate of the savings potential of your concept?

Jascha Rinke: Yes, together with Bindoc GmbH we have developed a system for calculating the savings potential, which provides a trend for the real savings potential. We defined a cluster of suitable elective operations and set specific guard rails within this cluster. On this basis, Bindoc was able to calculate the relevant figures. In the defined cluster, the result is that a median of around 0.55 preoperative occupancy days can be saved per case. This means that a hospital can save around 363 occupancy days per year by applying our EOP concept. Extrapolated to around 1,800 hospitals in Germany and average costs of €300 per day, the reduction in preoperative stays alone results in a significant savings potential in the hundreds of millions.

There will be a corresponding publication on this topic shortly, in which we will explain the details of the calculations and the exact figures in more detail.

On what basis did you define the cluster for your concept? What expertise and practical experience did you contribute and how does this flow into your concept?

Jascha Rinke: The cluster is based on our own practical experience from running a large practice clinic with over 8,000 procedures a year. We have refined this cluster over the years in close cooperation with more than 70 specialists in private practice who have worked in our clinic. In addition, we continuously compare this with the data from the Deutsche Praxisklinikgesellschaft (PKG e.V.).

To be fair, it must be taken into account that hospitals have a much more complex patient population. The cluster must therefore be adjusted individually for each hospital. However, there are also hospitals that have already successfully implemented this concept in practice.

Thank you very much for the interview! 

The content and statements presented in the interviews reflect the perspective of the interviewees and do not necessarily reflect the position of the editorial team.