Die Verankerung ambulanter Leistungsinhalte in den Krankenhäusern

Hospitals in Germany are currently under pressure due to various legislative initiatives that will massively change their future structure and service delivery as well as their economic situation owing to significantly increased costs. This particularly affects oral and maxillofacial surgery due to the fact that we provide practically no conservative inpatient treatments and also because the majority of our outpatient treatments are surgical in nature. Low-complexity procedures performed as inpatient treatments are only accepted and reimbursed by health insurance companies if so-called contextual factors are present. Without these contextual factors, the procedure can still be provided on an inpatient basis but will not be accepted by the health insurance as a proper inpatient service and are often converted by the hospital into an outpatient case, which is economically disastrous for the clinic. This “triage,” determining whether a surgical procedure should be performed on an in- or an outpatient basis, must occur in the clinic’s outpatient department—ideally during the first contact. The clinic’s outpatient department remains the portal for referring physicians but also becomes the location of surgery for referred patients whose services are no longer reimbursed on an inpatient basis. The organizational form of the outpatient clinic as a medical care center offers many advantages, especially for departments of oral and maxillofacial surgery.