Business Cases

Establishment of acute geriatrics as a center for senior surgery.

The hospital was able to generate an advantage from the fact that a high proportion of patients are > 70 years of age. Under the Bavarian Geriatrics Program, beds can be converted into acute geriatric beds once the structural requirements are met.

The structural requirements for geriatrics (as per OPS):

• Treatment by a geriatric team under specialist treatment management.
• Standardized geriatric assessment
• Social assessment on previous status in at least 5
• Weekly team meeting with participation of all professional groups with weekly documentation of previous treatment results and further treatment goals
• Activating-therapeutic care by specially trained nursing staff
• Team-integrated use of at least 2 of the following 4 therapy areas

inspiring-health has performed the following projection calculation:

• Identification of all patients 70 years and older
• Identification of MDCs in which geriatric complex treatment is possible
• Determination of the current case numbers, the VwD as well as the CaseMix (ACTUAL data 2010)
• Simulation calculation for additional revenues (assumption: 30%-50% of patients are treated geriatrically)
• Determination of the required beds from Vwd new, number of patients, utilization 80% à result: approx. 40 beds geriatrics
• Determination of additional costs by planning personnel along the above-mentioned guidelines and material cost share of geriatric DRGs
• No additional costs were estimated for administration and infrastructure.

Development of a contribution margin calculation for a bariatric center

Up to now, the development and expansion of bariatric centers has mostly been carried out on the initiative of the head surgeon with internal departmental resources. This does not always involve a planned, strictly process-oriented analysis. Successful bariatric center start-ups appear to be based on the following factors:

• Early involvement of hospital management and involved commercial departments.
• Strategic decision of the hospital management including all involved, medical departments
• Investment plan (infrastructure, personnel)
• Clear project management structures
• Marketing concept

inspiring-health developed a contribution margin calculation tool for various constellations based on the information already available:

• Hospital with own MVZ or own authorization to cover the outpatient process steps
• Hospital with external partner to cover the outpatient process steps
• The contribution margin calculation covers revenues and costs based on personnel expenses of the outpatient and inpatient area.

Quality improvement in the therapy of malnutrition

inspiring-health conducted a simulation calculation to determine whether the structured recognition, treatment and coding of malnutrition - a common phenomenon among elderly patients - can generate additional revenue. Together with a partner, inspiring-health developed the concept "QTM - Quality Enhancement in the Therapy of Malnutrition".

Here, patients are screened in a structured way for the risk of malnutrition, provided with supplements (in normal meals or as sip feeds) if malnutrition is present, and the expenses are coded using special ICD codes. Screening is performed by nursing and a dietitian. The therapy takes place during the inpatient stay. Upon discharge, the physician providing further treatment receives information on how therapy should ideally be continued.
In addition to the increase in the quality of diagnostics and therapy, some patients also generate higher revenues in the DRG system, which are usually far sufficient to cover the costs of the project.