Bettina Fuisting

Publications (3)2.73 Total impact

• Article: Analyse der Erlössituation bei der ambulanten Behandlung nach § 116 b SGB V am Beispiel des Marfan-Syndroms

  Marie-Luise Manow, Nesrin Paulsen, Meike Rybczynski, Thomas Mir, Alexander M. J. Bernhardt, Hendrik Treede, Gunda Ohm, Bettina Fuisting, Uwe Rehder, Florian Meier, Marina Vogler, Thomas Meinertz, Karin Overlack, Yskert von Kodolitsch
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  ABSTRACT: Hintergrund: Das Marfan-Syndrom ist eine typische Seltene Erkrankung mit Multisystembeteiligung und Erfordernis der spezialisierten medizinischen Versorgung. Die Richtlinie über die ambulante Behandlung im Krankenhaus nach § 116 b SGB V soll durch verbesserte Vergütungsmöglichkeiten eine hochwertige medizinische Versorgung in Klinikambulanzen ermöglichen. Die Autoren legen die erste Auswertung einer Kosten- und Erlösrechnung in der ambulanten Versorgung von Marfan-Patienten nach § 116 b vor. Methodik: Innerhalb 1 Jahres wurden 184 Fälle entsprechend § 116 b versorgt. Die Autoren ermittelten die Kosten der medizinischen Leistungen entsprechend der internen Leistungsverrechnung auf Basis des Hauskatalogs ihrer Klinik. Die Erlöse ermittelten sie zum einen nach den Vorgaben des § 116 b [Erlöse(§116b)] und zum anderen entsprechend der Pauschale für Hochschulambulanzen gemäß § 117 SGB V [Erlöse(§117)]. Ergebnisse: In 117 Fällen (64%) reisten die Patienten aus < 50 km, in 27 Fällen (15%) aus ≥ 50 bis ≤ 100 km und in 40 Fällen (22%) aus > 100 km Entfernung von der Klinik an. Die Kosten der medizinischen Leistungen lagen bei insgesamt 71 606,28 Euro. Die Erlöse(§116b) betrugen demgegenüber insgesamt 55 549,87 Euro und die Erlöse(§117) 11 776,00 Euro, womit eine Unterdeckung von 16 056,41 Euro bei Abrechnung nach § 116 b (22%) bzw. von 59 830,28 Euro bei Abrechnung nach § 117 (84%) vorlag. Schlussfolgerung: Die teilweise lange Anreise zu spezialisierten Zentren wird offenbar zugunsten verbesserter medizinischer Versorgung in Kauf genommen. Zentralisierte ambulante Versorgung erfordert jedoch eine gute Vernetzung mit wohnortnahen medizinischen Leistungserbringern. Die Abrechnung medizinischer Leistungen nach § 116 b hat trotz 22%iger Unterdeckung der Kosten zu einer deutlichen Verbesserung der Erlössituation geführt. Die Qualität der medizinischen Versorgung konnte dadurch gebessert werden. Background: The Marfan syndrome is a typical rare disease with multiorgan involvement and the need for specialized interdisciplinary medical care. A novel German legal directive according to section sign 116 b of the Social Statutes Book V (§ 116 b SGB V) improves options for reimbursement and thus encourages specialized hospitals to provide ambulatory care for rare diseases such as Marfan syndrome. The authors provide the first economic analysis of § 116 b in a German Marfan center. Methods: The costs were assessed in 184 cases with Marfan syndrome receiving medical care in the Hamburg Marfan Clinic. The authors assessed the financial profit both according to payments received from invoices established according to the § 116 b directive [reimbursement(§116b)] and from calculations according to § 117 SGB V [reimbursement (§117)]. Results: A total of 117 patients traveled to the Marfan clinic (64%) < 50 km, 27 patients (15%) between ≥ 50 and ≤ 100 km, and 40 patients (22%) > 100 km. The total costs for ambulatory care were 71,606.28 Euros. The reimbursement(§116b) was 55,549.87 Euros and the reimbursement(§117) was 11,776.00 Euros. Conclusion: Many patients accept long distances of traveling to receive specialized ambulatory medical care. However, for optimal patient management specialized centers need to cooperate intensively with local health care providers. The novel legal directive according to § 116 b has significantly improved reimbursement for Marfan centers and allows for improving the quality of medical care. Schlüsselwörter: Marfan-Syndrom-Loeys-Dietz-Syndrom-Kosten- Erlöse-Ambulante Behandlung Key Words: Marfan syndrome-Loeys-Dietz syndrome-Costs-Reimbursement-Ambulatory care
  04/2012; 105(8):529-537.
• Article: [Analysis of costs and profits of ambulatory care of Marfan patients after initiation of a novel German legal directive (116 b SGB V)].

  Marie-Luise Manow, Nesrin Paulsen, Meike Rybczynski, Thomas Mir, Alexander M J Bernhardt, Hendrik Treede, Gunda Ohm, Bettina Fuisting, Uwe Rehder, Florian Meier, Marina Vogler, Thomas Meinertz, Karin Overlack, Yskert von Kodolitsch
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  ABSTRACT: The Marfan syndrome is a typical rare disease with multiorgan involvement and the need for specialized interdisciplinary medical care. A novel German legal directive according to section sign 116 b of the Social Statutes Book V (116 b SGB V) improves options for reimbursement and thus encourages specialized hospitals to provide ambulatory care for rare diseases such as Marfan syndrome. The authors provide the first economic analysis of section sign 116 b in a German Marfan center. The costs were assessed in 184 cases with Marfan syndrome receiving medical care in the Hamburg Marfan Clinic. The authors assessed the financial profit both according to payments received from invoices established according to the 116 b directive [reimbursement (116b)] and from calculations according to section sign 117 SGB V [reimbursement (117)]. A total of 117 patients traveled to the Marfan clinic (64%) < 50 km, 27 patients (15%) between >or= 50 and <or= 100 km, and 40 patients (22%) > 100 km. The total costs for ambulatory care were 71,606.28 Euro. The reimbursement (116b) was 55,549.87 Euro and the reimbursement (117) was 11,776.00 Euro. Many patients accept long distances of traveling to receive specialized ambulatory medical care. However, for optimal patient management specialized centers need to cooperate intensively with local health care providers. The novel legal directive according to section sign 116 b has significantly improved reimbursement for Marfan centers and allows for improving the quality of medical care.
  Medizinische Klinik 08/2010; 105(8):529-37. · 0.34 Impact Factor
• Article: The spectrum of syndromes and manifestations in individuals screened for suspected Marfan syndrome.

  Meike Rybczynski, Alexander M J Bernhardt, Uwe Rehder, Bettina Fuisting, Ludwig Meiss, Ursula Voss, Christian Habermann, Christian Detter, Peter N Robinson, Mine Arslan-Kirchner, Jörg Schmidtke, Thomas S Mir, Jürgen Berger, Thomas Meinertz, Yskert von Kodolitsch
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  ABSTRACT: The diagnosis of Marfan syndrome (MFS) is based on evaluating a large number of clinical criteria. We have observed that many persons presenting in specialized centers for "Marfan-like" features do not have MFS, but exhibit a large spectrum of other syndromes. The spectrum of these syndromes and the distribution of "Marfan-like" features remain to be characterized. Thus, we prospectively evaluated 279 consecutive patients with suspected MFS (144 men and 135 women at a mean age of 34+/-13 years) for presence of 27 clinical criteria considered characteristic of MFS. The most frequent reasons to refer individuals for suspected MFS were skeletal features (31%), a family history of MFS, or aortic complications (29%), aortic dissection or aneurysm (19%), and eye manifestations (9%). Using established criteria, we confirmed MFS in 138 individuals (group 1) and diagnosed other connective tissue diseases, both with vascular involvement in 30 (group 2) and without vascular involvement in 39 (group 3), and excluded any distinct disease in 72 individuals (group 4). Clinical manifestations of MFS were present in all four patient groups and there was no single clinical criterion that exhibited positive and negative likelihood ratios that were per se sufficient to confirm or rule out MFS. We conclude that "Marfan-like" features are not exclusively indicative of MFS but also of numerous, alternative inherited diseases with many of them carrying a hitherto poorly defined cardiovascular risk. These alternative diseases require future study to characterize their responses to therapy and long-term prognosis.
  American Journal of Medical Genetics Part A 12/2008; 146A(24):3157-66. · 2.39 Impact Factor