[Diagnostics and Eradication Therapy for MRSA Carriers in the Outpatient Sector: an Analysis of the Reimbursement Situation in the Light of Current Reimbursement Changes]. / Diagnostik und ambulante Eradikationstherapie von Trägern mit MRSA in der vertragsärztlichen Versorgung ­ Eine Analyse der Erstattungssituation im Kontext aktueller Vergütungsveränderungen.

Infection with methicillin-resistant Staphylococcus aureus (MRSA) occurs in both the inpatient and outpatient sector. The reimbursement for diagnostic services and eradication therapy in the outpatient sector was regulated for the first time on 01.04.2012 and after a 2-year test period, has been adopted into the standard range of care services. The aim of this retrospective study was to give an overview of the current situation in services and reimbursement in Germany and describe MRSA patients and their treatment in the outpatient sector. Secondary data, namely reimbursement data of the National Association of Statutory Health Insurance Physicians (KBV) und the Physicians' Association (KV) Mecklenburg-West Pomerania for the period 01/04/2012-31/03/2014 were analyzed. Results show that on the federal level, MRSA services amounting to € 3,235,870.18 have been reimbursed and that diagnostic costs exceed treatment costs. In Germany, 5,627 doctors invoiced services related to MRSA; 51,56% of these were general practitioners and 21,25% specialists in internal medicine working in general practice. In the KV Mecklenburg-Western Pomerania, patients were elderly (average age 69,13), cost for services were on average 27,76 €, and 76,85% of the patients were treated within one quarter. On the whole, there were regional differences in the identification and eradication of MRSA in the outpatient setting. In order to provide an extended base for a more efficient resource allocation in the health care sector, in addition to analysis of MRSA eradication from the medical point of view, attention needs to be paid to patient flow between the out- and inpatient sectors, as well as economic aspects.

NHS pilots in primary care--an insight into the future?

UNLABELLED: This article looks at the background to the current changes in primary care dentistry being piloted in England. It looks at the structure of the different elements being piloted, such as the oral health assessment, interim care appointments and care pathways. It also examines advanced care pathways and how complex care will be provided when clinically feasible and beneficial to the patient. The authors have worked in a type 1 pilot practice since September 2010. CLINICAL RELEVANCE: The NHS contract currently being piloted in England delivers care through care pathways and clinical risk assessments with prevention as an important building block for the delivery of services. There are new measures planned for measuring quality outcomes in primary care. This has implications for how services are delivered, who delivers them and how dentists will be remunerated in the future.

[The groin hernia: in- or outpatient surgery?]. / Versorgung von Leistenhernien: ambulant oder stationär?

Because of the standardization of different surgical procedures, the surgical treatment of inguinal hernias can be primarily performed on an outpatient basis. The surgical traditions, the hitherto existing financial plan as well as the pretensions of our society, however, have promoted in hospital treatment of hernias. Only since 1993, in accord with the "German Gesundheitsstrukturgesetz", has a new general framework come into existence that has enabled hospitals to opt for ambulant treatment, as well. Because of the discrepancy between stationary and ambulatory funding, the ambulant approach nevertheless has not become widely accepted. This might change after the introduction of the catalogue of feasible ambulant treatments and non-stationary procedures, as well as by the recent nation-wide decisions regarding extra budgetary funding for ambulant treatments. To what extent the "German Vertragsarztrechtsänderungsgesetz" constitutes a stronger tie between private medical practice and hospital-bound outpatient treatment remains to be seen.

[Chronic wounds--perspective for integrated care]. / Chronische Wunden--Perspektiven der integrierten Versorgung.

In Germany more than 4.5 million people are treated for chronic wounds per year with resulting costs for the public health system up to five billion Euro. Within the next 30 years, the demographic development will result in a doubling of these numbers of patients. On the other hand, the social security systems have decreasing resources and are confronted with rising costs of modern medicine. New legislation was designed to limit costs and to enable new ways of cooperation between hospitals and practioners ("Intergrierte Versorgung" = IV) aside of fixed budgets. According to German legislation, the contract is made between practitioners, hospitals, rehabilitation units and homecare companies on the one hand and public health insurance companies on the other hand. When designing special contracts for IV, the strategic interests and expectations of the partners have to be analysed. In these complex models, financial as well as bureaucratic and others aspects of health care are to be considered including quality assessment. In the case of chronic wounds, specific in- and exclusion criteria, duration of the treatment period and clear end-points (treatment success or failure) have to be defined. Optimizing clinical pathways as well as improved process management should be possible with IV. Low-volume contracts with limited duration and well defined clinical features are probably the best way to establish IV for chronic wounds.

The influence of a continuum of care model on the rehabilitation of compensation claimants with soft tissue disorders.

STUDY DESIGN: Population-based before-and-after design with concurrent control group. OBJECTIVE: As continuums of care have been little studied, we evaluated the impact of the Workers' Compensation Board of Alberta (WCB-Alberta) model on sustained return to work, satisfaction with care, and cost. SUMMARY OF BACKGROUND DATA: Musculoskeletal conditions, such as back pain, continue to be leading causes of disability and work loss. From 1996 through 1997, the WCB-Alberta implemented a continuum of care model to guide rehabilitation service delivery for claimants with soft tissue injury. The model was designed as a decision-making tool to promote a consistent, evidence-based approach to care within the jurisdiction. METHODS: The model was implemented province-wide so the entire population of workers insured by the WCB-Alberta was studied. Data were extracted from the WCB-Alberta administrative database from 2 years before implementation (1994-1995) to 5 years after (1996-2000). An intervention group was created from patients filing soft tissue injury claims for the low back, ankle, knee, elbow, and shoulder. The comparison group was formed of workers experiencing fractures or other traumatic non-soft tissue injuries. Satisfaction was measured through surveys. Primary outcome was cumulative days receiving wage replacement benefits. Multivariable Cox regression was used to determine the model's effect. RESULTS: Over the entire study period, 70,116 claimants filed soft tissue injury claims while 101,620 claimants experienced non-soft tissue injuries. Significant improvement was observed in intervention group return-to-work outcomes after model implementation (hazard ratio = 1.54). Median duration of benefits decreased from 13 to 8 days. Little change was seen in the control group's disability duration (median duration, consistently 10 days). The majority of claimants were satisfied with care received. Cost savings over a 2-year full implementation period was $21.5 million (Canadian). CONCLUSION: Implementation of a soft tissue injury continuum of care involving staged application of various types of rehabilitation services appears to have resulted in more rapid and sustained recovery.

Cost efficiency in primary care contracting: a stochastic frontier cost function approach.

The principal aim of this paper is to estimate a stochastic frontier cost function and an inefficiency effects model in the analysis of the primary health-care services purchased by the public authority and supplied by 180 providers in 1996 in Catalonia. The evidence from our sample does not support the premise that contracting out has helped improve purchasing cost efficiency in primary care. Inefficient purchasing cost was observed in the component of this purchasing cost explicitly included in the contract between purchaser and provider. There were no observable incentives for the contracted-out primary health-care teams to minimise prescription costs, which were not explicitly included in the contracting system.