Private hospital in public healthcare system

Transcription

1 Private hospital in public healthcare system Priv.-Doz. Dr. H.T.Baberg HELIOS Klinikum Berlin-Buch

2 Agenda Challenges in the German hospital sector HELIOS structures and history Aligning a Hospital Network Quality management 1

3 Pflegesatz vs. Fallpauschale 2

4 Pflegesatz Until 2004 hospitals were paid per day a patient stayed. The payment per day were negotiated with the (few) insurance companies in advance. Predefined services (operations, MRT) were refunded separately. Revenue = days of stationary stay x Pflegesatz of the Department For Example Appendectomy: 7 days of stationary stay x 335 Pflegesatz =

5 Fallpauschale successive Implementation of the German Diagnose Related Groups System (G-DRG) Each medical case gets grouped into one of over DRG s Each DRG has a defined case weight Each federal land has a defined and negotiated baserate Revenue = case weight x baserate For Example Appendectomy: Baserate Berlin x case weight [Appendektomie ohne CC] 0,81 =

6 Changes in the German hospital sector Number of hospitals Hospital beds patients Length of stay physicians 1) Non-physician staff 1) -15,3% -24,7% +25,5% -6,3 days +45,6% -10,2% ,6 Mio. 18,3 14 7,7 Tage ) full-time equivalents Quelle: Statistisches Bundesamt Changes from 1991 to

7 Changes in the German hospital sector Number of hospitals Hospital beds patients Length of stay physicians 1) Non-physician staff 1) -15,3% -24,7% +25,5% -6,3 days +45,6% -10,2% ,6 Mio. 18,3 14 7,7 Tage ) full-time equivalents Quelle: Statistisches Bundesamt Changes from 1991 to

8 Changes in the German hospital sector Number of hospitals Hospital beds patients Length of stay physicians 1) Non-physician staff 1) -15,3% -24,7% +25,5% -6,3 days +45,6% -10,2% ,6 Mio. 18,3 14 7,7 Tage ) full-time equivalents Quelle: Statistisches Bundesamt Changes from 1991 to

9 Changes in the German hospital sector Number of hospitals Hospital beds patients Length of stay physicians 1) Non-physician staff 1) -15,3% -24,7% +25,5% -6,3 days +45,6% -10,2% ,6 Mio. 18,3 14 7,7 Tage ) full-time equivalents Quelle: Statistisches Bundesamt Changes from 1991 to

10 Impact on hospitals Comparable cases earn comparable money in all German hospitals Patients can got to every German hospital they want We need as many patients as possible to work efficient and make revenue COMPETITION!!! 9

11 Impact on hospitals Economically operating hospitals make profits Mismanaged hospitals make losses that need to be compensated by the shareholders (usually towns and counties) Investments are needed to make hospitals efficient BUT: Subsidies, that should be paid by the federal land fall since years Therefore hospitals have to earn money to invest themselves Development of Subsidies (1991 = 100) 1991 = West Ost * Quelle: DKG 10

12 Hospital Sector Hospitals 1999 = Öffentlich Public Freigemeinnützig Non-Profit Private

13 The hospital sector in Germany (2011) public Non-profit privat HELIOS Hospitals 623 (30,5%) 741 (36,3%) 677* (33,2%) 50 (2,4%) Cases 9,1 Mio. (49,7%) 6,3 Mio. (34,3%) 2,9 Mio. (16,0%) 0,63 Mio. (3,45%) Beds (48,6%) (34,2%) (17,2%) (3,2%) Length of stay (d) 7,7 7,5 8,2 6,7 * mehr private als öffentliche Krankenhäuser, aber - Zählweise der Krankenhäuser fraglich - Bettenzahl ist eher maßgeblich 12

14 Agenda Challenges in the German hospital sector HELIOS structures and history Aligning a Hospital Network Quality management 13

15 HELIOS inkl. Damp Asklepios inkl. Mediclin Rhön Sana Schön Klinik SRH Ameos Paracelsus Capio Deutsche Klinik* Die Trägerlandschaft der Akutkliniken in Deutschland Die zehn größten privaten Krankenhausträger * 2010 (Umsatz-Zahlen 2011 noch nicht veröffentlicht) ** Asklepios ist seit September 2011 Mehrheits-Aktionär (52%) der MediClin AG, gesamter Umsatz 2011 von Mediclin berücksichtigt (493,6 Mio. ), Konsolidierung ab ***HELIOS ist seit März 2012 Mehrheitsaktionär der Damp Holding AG, gesamter Umsatz 2011 (417,5 Mio., ohne Wismar) von Damp berücksichtigt. Quelle: Eigene Darstellung der Zahlen von 2011/2010, basierend auf öffentlich verfügbarem Zahlenmaterial privater Betreiber 14

16 HELIOS: the beginnings Founder: Dr. Lutz Helmig, vascular surgeon, pioneer from the early days of hospital privatisation Founded in 1994 with four hospitals in Bad Schwartau, Bleicherode, Bochum and Volkach 15

17 HELIOS growth Sustained growth Umsatz (in Mio. EUR) EBIT (in Mio. EUR) ,3% 8,6% Umsatz 8,2% EBIT 8,8% 7,8% 8,9% 8,2% Increase in revenues and earnings HELIOS has doubled its revenues every three to four years 16

18 Fresenius SE & Co. KGaA International healthcare group more than 150,000 employees Revenues of 16.5 billion Fresenius Biotech Cancer and immunotherapy Fresenius Medical Care Fresenius Kabi Fresenius Helios Fresenius Vamed Dialysis products and services Infusion and nutritional therapies Hospital business run by executing body Engineering and services Status: 2011 fiscal year 17

19 HELIOS Kliniken 72 hospitals - 6 maximum care hospitals - 22 rehabilitation hospitals - 30 outpatient centers > employees 2,7 Million patients per year* inpatients 95,8% of the DRGs (*Umsatz und Patientenzahl im Jahr 2011) 18

20 HELIOS Konzernstruktur 19

21 Agenda Challenges in the German hospital sector HELIOS structures and history Aligning a Hospital Network Quality management 20

22 Target and track Best possible care of our patients - Large network of 70 hospitals - Cross-sector knowledge sharing Measurement and improvement of the quality of our medical treatment - Care, transparency, honesty Competence in all areas of patient care - Acute care (inpatient/outpatient), rehabilitation, care for the elderly 21

23 24 HELIOS Specialist Groups The engine of medicine in the corporation Decisions on various guidance s Two annual specialist group meetings for every medical discipline Patient benefits Economic efficiency Knowledge Growth Members: - All chief physicians of the relevant area - One member of the board - One member of the medical board - One member of the department of medical development Spokesman of all medical groups: Prof. Dr. med. Josef Zacher 22

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25 Medical Board Eight Chief physicians of different HELIOS Hospitals and the head of the Specialist Groups Function - Supporting the Management in medical planning, in the specialist groups, the regions and the hospitals - Supporting he Peer-Reviews - Integration of new hospitals in the groups Dr. Herta Ratayski Priv.-Doz. Dr. Henning T. Baberg Dr. Wolfgang Krahwinkel Prof. Dr. Andreas Meier-Hellmann Prof. Dr. Dieter Bach Prof. Dr. Patrick Haage Dr. Michael Liebetrau Dr. Ramona Ullmann 24

26 Example: Procurement Cardiology 25

27 Solving medical problems: Example Indikation zu ASS?! ASS abgesetzt durch Hausarzt - OP verschieben - ASS 100 mg p.o. 2 Wochen - Prä OP Vortag ASS 300 mg p.o. Bislang kein ASS jedoch präop. Indikation erkannt - s. oben - kardiologische Konsil Alleinige Clopidrogrel-Gabe - kardiologische Konsil Specialist group Urology Decided 9/ OP wie unter ASS 26

28 Benchmark - Sterilisation Zentralsterilisation (Nettogesamtkosten ohne AfA je OP- BWR) Ziel: < 30 Euro Klinik A 37,26 Klinik B 47,89 Klinik C 37,28 Klinik D 28,36 Klinik E 27,84 Volumen: 4,0 Mio. Viel Potenzial, zu viele Siebe/zu hohe Bestückung. 27

29 Agenda Challenges in the German hospital sector HELIOS structures and history Aligning a Hospital Network Quality management 28

30 HELIOS Quality management 46 im Detail veröffentlichte medizinische Qualitätsziele 29

31 Mortality in myocardial infarction in all HELIOS-hospitals SMR 2 1,8 1,6 1,4 1,2 1 0,8 0,6 0,

32 Mortality in myocardial infarction in Berlin-Buch QSR-Bericht der AOK für Berlin-Buch

33 Peer Review Verfahren Peer Review 32

34 Peer Review Principles Clarify statistically conspicuous findings Cases are selected centrally 3 Chief physicians from other hospitals visit the reviewed hospitals and check all cases Review team with specialists from different medical fields Cooperative and confidential consultation No backlash! Structured feedback in the reviewed department 33

35 Members of IQM 34

36 Example: pneumonia mortality in Berlin-Buch 1,5 1,4 1,3 1,2 1,1 1 0,9 0,8 0,7 0,6 0,5 Peer Review

37 Example: pneumonia mortality in Berlin-Buch 1,5 1,4 1,3 1,2 1,1 1 0,9 0,8 0,7 0,6 0,5 Peer Review

38 Results and consequences of the Peer Review Additional costs for a new senior physician pneumology No additional investment Department got more attractive for young doctors due to the new qualification offered Shorter length of stay due to strict antibiotic regime Less CT s and Bronchoscopies due to strict adherence to the guidelines Distinct rise of cases of patients with pneumonia (from 370 to 650) From 2010 till today we saved 28 lives! 37

39 Thank you very much! 38