Remuneração de três planos odontológicos da cidade de Maceió-AL em comparação à tabela VRPO-CFO / Remuneration of three dental plans from the city of Maceio-Al in comparison to the table VRPO-CFO

Objetivo: Investigar se o valor médio geral de remuneração ofertado por três planos odontológicos da cidade de Maceió-AL possuem defasagem, coerência ou ágio em relação ao estabelecido na tabela VRPO-CFO. Materiais e Métodos: foram utilizados três planos odontológicos da cidade de Maceió-AL,acreditando ser esses os de maior procura por parte dos profissionais, para uma comparação entre suas categorias de serviço e as da tabela VRPO, sendo calculado o valor percentual de acréscimo ou defasagem. Resultados: Nota-se que em todas as categorias de serviço, o plano que melhor remunerou foi o plano A, tendo as categorias prevenção, Endodontia, Radiologia e Dentística o menor percentual de defasagem, sendo eles 22%, 26%, 30% e 40%, respectivamente, as demais categorias apresentaram índice acima de 50%. O plano odontológico que pior remunerou, de acordo com a presente pesquisa, foio plano C, com média de defasagem geral de 65%, possuindo a categoria Diagnóstico como o serviço com maior defasagem (83%). Conclusão: Conclui-se que a remuneração dos procedimentos odontológicos,que envolvem todas as especialidades, oferecida por planos odontológicos de Maceió-AL aos Cirurgiões-Dentistas, estão abaixo dos valores determinados na tabela do VRPO-CFO.

Objective: To investigate whe ther the overall average amount of remuneration offered by three dental plans from the city of Maceió-AL have a discrepancy, consistency or goodwill in relation to the established VRPO-CFO table. Materials and Methods: three dental plans from the city of Maceió- ALwere used, believing that these are the most demanded by professionals, for a comparison betweentheir service categories and VRPO table, therefore calculating their increasement percentage valueor lag. Results: We notice that in all service categories, the plan that best remunerated was plan A,having the categories Prevention, Endodontics, Radiology and Dentistry the lowest percentage oflag, namely 22%, 26%, 30% and 40% respectively, the other categories had an index above 50%.The dental plan that pays worse, according to this research, was plan C, with an overall discrepancy average of 65%. Having the Diagnosis service category with the largest lag (83%). Conclusion: We conclude that the remuneration for dental procedures, involving all specialties offered by dental plans in Maceió (AL) to dentists, are lower than the ones determined on the VRPO-CFO table.

Orthopedics coding and funding.

The French tarification à l'activité (T2A) prospective payment system is a financial system in which a health-care institution's resources are based on performed activity. Activity is described via the PMSI medical information system (programme de médicalisation du système d'information). The PMSI classifies hospital cases by clinical and economic categories known as diagnosis-related groups (DRG), each with an associated price tag. Coding a hospital case involves giving as realistic a description as possible so as to categorize it in the right DRG and thus ensure appropriate payment. For this, it is essential to understand what determines the pricing of inpatient stay: namely, the code for the surgical procedure, the patient's principal diagnosis (reason for admission), codes for comorbidities (everything that adds to management burden), and the management of the length of inpatient stay. The PMSI is used to analyze the institution's activity and dynamism: change on previous year, relation to target, and comparison with competing institutions based on indicators such as the mean length of stay performance indicator (MLS PI). The T2A system improves overall care efficiency. Quality of care, however, is not presently taken account of in the payment made to the institution, as there are no indicators for this; work needs to be done on this topic.

Capture of complexity of specialty care in pediatric cardiology by work RVU measures.

OBJECTIVE: We sought to determine the relationship between relative value units (RVUs) and intended measures of work in catheterization for congenital heart disease. METHODS: RVU was determined by matching RVU values to Current Procedural Terminology codes generated for cases performed at a single institution. Differences in median case duration, radiation exposure, adverse events, and RVU values by risk category and cases were assessed. Interventional case types were ranked from lowest to highest median RVU value, and correlations with case duration, radiation dose, and a cases-predicted probability of an adverse event were quantified with the Spearman rank correlation coefficient. RESULTS: Between January 2008 and December 2010, 3557 of 4011 cases were identified with an RVU and risk category designation, of which 2982 were assigned a case type. Median RVU values, radiation dose, and case duration increased with procedure risk category. Although all diagnostic cases had similar RVU values (median 10), adverse event rates ranged from 6% to 21% by age group (P < .001). Median RVU values ranged from 9 to 54 with the lowest in diagnostic and biopsy cases and increasing with isolated and then multiple interventions. Among interventional cases, no correlation existed between ranked RVU value and case duration, radiation dose, or adverse event probability (P = .13, P = .62, and P = .43, respectively). CONCLUSIONS: Time, skill, and stress inherent to performing catheterization procedures for congenital heart disease are not captured by measurement of RVU alone.

[Do the New German OPS codes map the relevant therapeutic activities in psychiatric clinics?]. / Abbildung des psychiatrisch-psychotherapeutischen Leistungsspektrums durch die aktuellen OPS-Komplexcodes.

OBJECTIVE: Actual codes for operations and procedures (OPS) in psychiatry and psychosomatics should map cost separating therapeutic activities so far defined in Germany by the normative specifications of the psychiatry staff enactment (PsychPV). OPS codes should also allow re-estimating underlying therapy times. METHOD: Therapeutic activities of the PsychPV fulfilling the minimal criteria of the OPS definition were classified as multiples of a therapeutic 25 minute unit. RESULTS: Therapeutic activities of the PsychPV are mapped to OPS complex codes in a variable degree (psychiatrists 35 %, psychologists 42 %, nurses 43 %, special therapists 59 %). CONCLUSION: Actual OPS codes are inappropriate for identifying relevant cost-separating factors in the therapy of psychiatric in-patients. They cannot assure in their actual form the standards given by the PsychPV and need substantial revision.

[What changes for rheumatologists in the G-DRG system 2006?]. / Was ändert sich für die Rheumatologie im G-DRG-System 2006?

Once more, the revision of the German DRG catalogue 2006 provides for more accurate reimbursement, particularly for specialised medical services. The newly established DRG I97Z (Rheumatologische Komplexbehandlung bei Krankheiten und Störungen an Muskel-Skelett-System und Bindegewebe) for the complex and multimodal treatment of rheumatic diseases allows an accurate picture of clinical practice in specialized rheumatologic departments and hospitals. Using this specific DRG-description, it will be possible to reduce the financial pressure which results from the redistribution of budgets in the second year of the period of convergence. A precondition for the affected hospitals is to deal with budget planning and calculation of G-DRGs without calculated cost weights for 2006. In addition, this article discusses the relevance of other modifications to the G-DRG system, additional payments, the conditions for payment, the coding standards, and the classification systems for diagnosis and procedures.

[Developing rehabilitation treatment groups for cardiology and orthopaedics -- findings of a research project]. / Entwicklung von Rehabilitationsbehandlungsgruppen (RBG) für die Kardiologie und Orthopädie -- Ergebnisse eines Forschungsprojekts.

The call for a more specific and transparent service and reimbursement system for medical rehabilitation is not new. However, in practice, the idea was not followed up for a long time. This situation changed with the introduction of German Diagnosis Related Groups (DRGs) for acute care settings. It is now strongly being discussed whether such a sophisticated lump sum reimbursement system might also be a viable alternative in the field of rehabilitation. There still exist different opinions over the suitability of a lump sum-system for medical rehabilitation, but the main direction seems to be clear. There is no doubt that medical rehabilitation requires a needs-adapted, differentiated patient classification system. The benefits of such cost-homogeneous groups are evident. They support medical and management services and are suitable for both internal and external use. The main intent of the project presented was to develop such a patient classification system, adapted to the requirements of medical rehabilitation. The project concentrated on orthopaedic and cardiac rehabilitaton. For these two areas, needs-adapted and cost-homogeneous groups (RBG, Rehabilitationsbehandlungsgruppen - Rehabilitation Treatment Groups) were developed in order to adequately represent the underlying service portfolio and to act as a link between acute and post-acute care. In addition, severity level indicators were identified, in order to explain for different needs and resource volumes and in order to create severity-RBGs representing patients with the same severity level. Based on these groups, a needs-adapted lump sum reimbursement system can be developed, allowing for a differentiated service and cost controlling. The project described formed part of the Research Funding Programme Rehabilitation Sciences defrayed by the German Pension Insurance and the Federal Ministry for Education and Research. As part of the Freiburg/Bad Sackingen research network, it was realised at the University BW, Munich.