Ambulante Operationen und stationsersetzende Ma�nahmen

Abstract

Since January 2004, German hospitals and specialists in private practice have equal rights to provide and to charge for ambulatory surgeries according to paragraph 115b, 5th Code of Social Law. The current agreement between the German self-governing bodies replaces the existing contracts from 1993. In contrast to the previous version, the revised catalogue contains additional non-operative procedures. Some procedures may be provided either in an ambulatory or inpatient setting. However, for the hospitals it is of particular importance that some specified procedures should be performed on an ambulatory basis. If these particular services are delivered in an inpatient setting at least one stipulated criteria of exception has to be fulfilled. From the perspective of dermatology, not only opportunities but also obligations for ambulatory care arise from the new conditions. The critical facts and aspects with special relevance to dermatology are reviewed in detail.

Dermatology – a surgical discipline – as exemplified by surgical procedures at the Hospital of Munich Thalkirchner Strasse

“…The number of inpatient small operations (time factor < 20 minutes) has, with some variability, remained relatively constant over time; this may be explained by the increase in outpatient dermatologic surgical procedures [12–14]. The increase of small interventions in 2000–2004 is explainable by the additional removal of small premalig‐nant or malignant skin lesions such as actinic keratoses or superficial truncal basal cell carcinomas in patients treated on an inpatient basis for a larger operation (Figure 1a).…”

“…In 2005 the number returned to the mean of the previous years (Table 2, Figure 3). This may be due to the better reimbursement of outpatient surgical procedures, but at any rate also due to promotion of outpatient surgery and limitations on inpatient procedures by the statutory health insurance funds [12–14].…”

“…These share borders with other surgical specialties such as ophthalmology, oro‐maxillary and facial surgery and ENT. The authors emphasize that dermatology traditionally is a conservative and surgical specialty which after all is reflected in the postgraduate training regulations [4, 13].…”

“…As the number of statutory health insurance‐authorized physicians will not rise in the next future, dermatologists have here a diverse but also laborious and challenging field of activity to look forward to. With increasing comorbidities a further increase in partially inpatient and inpatient surgical services in dermatology can be expected [12, 13, 20, 21].…”

Current situation of dermatologic surgery in Germany

“…Operations are performed in dermatology departments, outpatient clinical centers and dermatologists' private offices. The type and severity of the disease, the size and complexity of the operation, the available medical resources and the medical‐organizational infrastructure and, last but not least, existing or anticipated complications or comorbidities of the patient determine if treatment is done in the hospital or office setting [6, 7]. Small operations of short duration and little tissue trauma are usually an outpatient procedure in the office.…”