where does the money for the care?


My last blog post I finished by saying that the work of the nurse can serve on paper to the people. There, I was referring to the aspect of quality assurance. Today I would like to offer a different angle of view and the financing of our nursing services lighting.

Who pays for the care of the patient

The nursing and medical care of patients paid for in Germany by the health insurance contributions of the population. All of the services that we provide in hospitals such as surgery, Dressing changes, administration of food, the body care of patients and so on, are settled on the so-called DRG System with the health insurance companies. DRG stands for Diagnosis Related Groups and diagnosis related groups. In a nutshell, that means that the hospital for each Patient who has the same diagnosis – for example, a broken Arm gets the same amount of money from the health insurance companies. Everything is, therefore, to supply a patient with a broken Arm needed, must be funded out of this amount of money the insurance company pays for this diagnosis. The lunch of the patients, the bandages, the medicines that he needed and much more. Of these revenues, the hospital must also ensure that the salaries of the employees pay, the care of the patient.

Fracture of the arm is not the same as fracture of the arm

We stay with the example of fracture of the arm. Quickly, the question is, whether for all patients with a broken Arm, the same care is necessary or appropriate. Again an example: In the emergency room two patients are admitted with the same diagnosis. Patient 1 is a 32 years old and skiing overthrown, unfortunately, he broke his Arm. Patient 2 is 81 years old and stumbled on the way to the ringing telephone in his apartment, he has broken his Arm. Patient 1 is otherwise healthy. Patient 2 has a few more diseases: He is diabetic, has high blood pressure and a protective wearing pants, because he can’t hold the urine. Of course, both need surgery. But while Patient 1 is shortly after the OP, completely independently, is in need of Patient 2 during the entire hospital stay, a lot of support from the nursing staff. It has to be helped when Washing, regularly he needs to get a bed pan and handed to you or him need to be changed, the protective pants, he needed drugs and syringes in case of too high blood sugar values. The care of the Patient 2 will cost so much more than the care of the Patient 1. However, for both is paid by the health insurance of the same amount. Thus, the hospital does not remain on the cost of Patient 2 seats, the DRG System is the ability to, in addition to diagnoses and procedures to be settled. Thus, we can provide the health insurance for the complex care and diabetes.

No blind trust: documentation required

Since it is a lot of money, believe us, the health insurance, of course, not blind, that we had due to the in addition to diagnoses more effort with the patients. We need to demonstrate in the patient’s file through our documentation that we have made the necessary nursing services. To check this, there is a between instance. The Medical service of the health insurance funds (MDK) checks in inspections of the hospitals, and by reviewing the patients ‘ files whether or not the services are billed. For the MDK, the guiding principle is: Only what is written in the acts, was also made. No evidence for our nursing services, are to be found in the documentation, you will not be paid by the insurance company. The hospital is in the plight that our salaries must be paid to receive on the other hand, revenue for our work by the insurance companies.

The heart of nursing

I think, for all the people who go into the profession of nursing, is the biggest incentive to work with people and help them. This fact will, hopefully, always remain at the heart of nursing. But to care for the sick of today, a whole lot of Desk work. Just as a craftsman who writes his invoice to the customer, we will provide with our nursing documentation is the invoice for our work on the health insurance of the patient.

Source: Fotolia/ sudok1