Chief Medical Clinic Manager of a University OB/GYN Clinic – An Innovative Job Description as Management Response for Increase of Profitability, Quality of Care, and Physicians’ Freedom of Action

Abstract

Leadership structures in German clinics are adjusting parallel to DRG (diagnose-related groups)-induced economic reorientation of the health care system. A Chief Medical Clinic Manager (CMCM) is a new job description and an innovative approach to combine medical competence and business economics at the operational level of care. The ideal qualification is a medical specialist in the clinical field with practical experience in patient care and leadership as well as in hospital economics and quality control. A CMCM is placed at a superior level in the clinic, with authorizing competence for the entire physician team. Main tasks are cost transparency within the clinic, organizational development by structured processes, and financial and strategic controlling of all business aspects. A CMCM induces change management and financial adjustment of care to reimbursement with maintaining the standard of care. In cooperation with the director of the clinic, a CMCM develops a vision for clinic development, an investment strategy, and a business plan. The success parameters are positive operative results of the clinic, cost-covering care, increased investment rate, employee satisfaction, and implementation of innovations in research and therapy. A CMCM thereby increases financial and organizational freedom of action at the clinic level in a non-profit public health care system.

Comparison of Actual Hospital Costs versus DRG Revenues for In-Patient Treatment of Febrile Neutropenia during Adjuvant Anthracycline plus/minus Taxane-Based Chemotherapy for Primary Breast Cancer

“…However,inaflat-ratediagnosis-relatedgroup(DRG)reimbursementsystem,ahospital'sowncostsfordiagnosisand treatmentaswellasformaterialexpenses [3]shouldnotexceedtheactualreimbursement,whichequalsthetargetcosts fromtheprovider'sperspective.Thisrequiresacomprehensive understanding of the hospital costs, material expenses andconsumptionofotherresourcesaswellasadjustmentand activesteeringprocessesattheoperativecliniclevel [4].This is even more important in entities like cancer with high resource consumption, e.g. oncological medication [5][6][7][8] or breastimplants [3],especiallyinprophylaxis [9]andtreatment of febrile neutropenia [10][11][12] and also in clinical trials [13,14].…”

Relevance of Health Economics in Breast Cancer Treatment: Integration of Economics in the Management of Breast Cancer at the Clinic Level

“…Successful microeconomic projects in breast centers require active management and the integration of management at the clinic level [24,25]. Clinical resource steering requires timely access to all relevant cost and reimbursement information.…”

“…This has already proven to be cost-effective, e.g. understanding of costs for chemo-related febrile neutropenia prophylaxis medication vs. their reimbursement [48], reducing in-patient costs for chemotherapy by €900,000 per year [28], and has even lead to a new profession [24,25]. …”

Financial Quality Control of In-Patient Chemotherapy in Germany: Are Additional Payments Cost-Covering for Pharmaco-Oncological Expenses?

“…Hospital costs have to be determined and compared to entity-related revenues in order to provide cost-covering care [7,8]. Expensive oncological pharmaceuticals [9] are the primary cost drivers for in-patient therapy, which have to be monitored closely [10] to not exceed their reimbursement by ZEs [11]. ZEs are revenues on top of the flat rate DRG payment, e.g.…”

“…trolling tools is necessary, preferably implemented inside an oncological department in order to influence the costs right at the level of care [10].…”