[Chances and risks of conversion to outpatient treatment in trauma surgery and orthopedics]

At the latest since the Medical Services Healthcare Insurance Reform Act (MDK), the declared will of the legislation is the conversion of operations previously carried out in an inpatient setting to an outpatient setting. In trauma surgery and orthopedics numerous operations are carried out that could principally also be performed in an outpatient setting; however, a prerequisite is a medical assessment of the suitability of patients as well as an economic and normative framework that makes outpatient surgery attractive. Both the Outpatient Surgery in Hospitals Catalogue (AOP-Katalog) and the first edition of the Hybrid Diagnosis-related Groups (DRG) define interventions in trauma surgery that could be carried out in an outpatient setting. Hospitals are therefore required to find solutions for these interventions under processual and economic provisos. These range from omission of outpatient operations to the expansion as a separate financial department in the hospital. With the introduction of the hybrid DRG, the legislation enables equal remuneration for outpatient versus short-term inpatient treatment and leaves the case management up to the hospital; however, the performance of the AOP in the setting of a hospital and also hybrid case flat rates are as a rule not economically viable and bear the risk of the failure of all efforts at conversion to outpatient settings. It is necessary to carry out a fundamental revision of the remuneration and framework conditions for outpatient operations in trauma surgery and orthopedics in hospitals, involving practitioners. This is the only way that the conversion to outpatient treatment can succeed.