Hospital.Help

Berlin – The traffic light coalition wants to enshrine uniform standards and specifications for the emergency services, which are mostly organized regionally, in the planned emergency law. Both projects will be discussed by experts in the Health Committee tomorrow, Wednesday.

The reform of emergency and rescue services are building blocks three and four of the hospital reform by Federal Health Minister Karl Lauterbach (SPD). The first component – ​​the Hospital Transparency Act – has been in force since the beginning of the year.

The second component – ​​the Hospital Care Improvement Act (KHVVG) – which is considered the heart of the reform, was passed in the Bundestag two weeks ago. The vote in the Federal Council is due on November 22nd.

The rescue service is to be reformed – as already announced in recent months: Instead of being the exclusive responsibility of the federal states and municipalities, as was previously the case, emergency medical care is to become part of the Social Security Code (SGB) V and thus at least meet the requirements for quality in the be the hand of the covenant.

There are several amendments to the law that will also be part of the committee hearing tomorrow. For example, the applications specify the entitlement of those with statutory health insurance to emergency management, emergency medical care on site and possible emergency transport.

Emergency transport and medical travel are therefore defined separately. This is intended to prevent patients from being taken to a hospital for billing reasons, even though on-site care would be sufficient.

In order to define the quality standards in emergency rescue more precisely, an “Emergency Rescue Quality Committee” is to be set up at the Federal Ministry of Health. Four representatives from the National Association of Statutory Health Insurance Funds and the federal states will meet there and advise the ministry on “all questions relating to medical emergency rescue”. The committee will also discuss recommendations for data transmission and digital emergency documentation.

The committee should also deal with the promotion of first aid by laypeople and the involvement of registered first aiders via mobile alarm apps. The focus is also on the use of standardized and networked software in control centers across district and state borders.

With the emergency law, to which the changes to the emergency services are now being integrated, the federal government wants to ensure better patient management and an expansion of care offerings and thus relieve the burden on emergency rooms.

This also applies, for example, to the plans to oblige the associations of statutory health insurance physicians to consistently provide telemedicine and outpatient care. In addition, in the future, so-called acute control centers of the KVen will carry out the previous tasks of the appointment service point in the area of ​​acute case placement and will be networked with the rescue control centers in a “health control system” – including mutual digital case handover.

Mandatory INC

Mandatory participation of KVs and selected hospitals in integrated emergency centers (INZ) should also be implemented. The locations are to be determined by the self-governing partners in the expanded state committee according to uniform nationwide guidelines.

The two projects, which are now regulated in one law, are assessed differently by medical organizations, health insurance companies and hospital representatives. In principle, many self-administration organizations in the healthcare sector welcome the fact that the emergency services should now also be integrated into the law.

An even more “consistent link” with current reform projects such as the hospital structural reform (KHVVG) and the Health Care Strengthening Act (GVSG) is being called for, for example, by the umbrella association of company health insurance companies.

“The present amendments finally address this by placing emergency medical rescue – consisting of emergency management, emergency medical care and emergency transport – on a new basis. A stronger integration of the rescue service into cross-sector care is essential,” said Franz Knieps, CEO of the BKK umbrella organization in the run-up to the hearing.

However, the German Hospital Association (DKG) is critical of linking emergency and rescue service reform in one law. “We therefore advocate that questions relating to the emergency services should be excluded for the time being and developed in a separate law together with the states. This ensures that the important emergency reform can be implemented promptly,” explained the CEO of the DKG, Gerald Gass, in a statement.

For the National Association of Statutory Health Insurance Physicians (KBV), the emergency reform is not well thought out: “The draft law does not go beyond a few good approaches, such as the further development of the structures around the number 116117 into an acute control center and an appointment service center,” say the three board members Andreas Gassen, Stephan Hofmeister and Sibylle Steiner.

The law “completely fails” to reduce the burden on emergency rooms. Because: “The opening of emergency departments at the so-called Integrated Emergency Centers (INZ) in hospitals during practice opening hours, as envisaged in the current draft, creates a disorderly coexistence of several contact points.” In addition, the question remains as to how the “scarce resource of doctor’s time” should be fulfilled.

The General Practitioners Association sees it similarly. “Unfortunately, after a few sensible approaches, the planned law veers towards “whatever you wish”. Double and triple offers are being promised here for which there is no staff and which would neither make sense nor be expedient,” said the two federal chairmen Nicola Buhlinger-Göpfarth and Markus Beier.

The German Medical Association (BÄK) said that there were not enough doctors available to ensure the nationwide 24/7 telemedical and outreach emergency care provided for in the draft and to be able to staff the planned emergency practices after hours.

“The time and scope should therefore be clarified as needed in joint committees at the state level with the involvement of the state medical associations,” said BÄK Vice President Ellen Lundershausen. With regard to the inpatient sector, she emphasized that the planned realignment of hospital planning and reimbursement must be designed in such a way that the inpatient care of complex, multimorbid emergency patients and the necessary provision are adequately refinanced.

In its written statement for the committee hearing, the BÄK also emphasizes the great importance of health literacy and health system competency in connection with emergency care.

“Many people – often out of ignorance – seek out structures that do not meet their needs. As long as no intensive educational work is carried out here and as long as health literacy is not strengthened from childhood and in people’s living environments, it can be assumed that the number of people seeking help will not decrease, but rather increase and that well-intentioned care paths will not be accepted by the population. “

The Association of University Hospitals (VUD) assesses the project positively: “The reform of emergency care, like the hospital reform, is an important building block for more efficient care. On the one hand, it is important and correct to locate integrated emergency centers (INZ) at selected and professionally suitable hospitals and to assign them the lead,” says Jens Scholz, 1st Chairman of the VUD. And Scholz further emphasizes: “These must primarily be hospitals with G-BA emergency levels 2 and 3.”

Other associations emphasized that the question of financing the expansion of the offer was still unclear. This is highlighted by the KBV, for example. Those involved in statutory and private health insurance appear questionable about their assessment of the savings potential.

“The savings potential of up to one billion euros per year described in the draft law is incomprehensible,” says Carola Reimann, CEO of the AOK Federal Association, for example.

“The federal government’s reform law continues a problematic trend: As with the hospital reform and long-term care insurance, it shifts the costs of general services to the social insurance contributors,” explained Florian Reuther, director of the PKV Association. GKV and PKV should not have to bear these costs; the PKV should not be allowed to share in the costs at all. © bee/aerzteblatt.de