Emergency services reform must be transformed into emergency reform…

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Written By Kampretz Bianca

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Karl Lauterbach (SPD), Federal Minister of Health. /image alliance, nordphoto GmbH, Meuter

Berlin – The planned reform of emergency services should be integrated into the emergency reform in the parliamentary process. Federal Minister for Health Karl Lauterbach (SPD) announced this today at a specialist event on emergency care and rescue services by ADAC Luftrettung.

This means there probably won’t be a separate account for emergency services. This was originally planned. Instead, content is expected to be introduced into the legislative process using formulation assistance. Reform of emergency care and rescue services must be thought of in conjunction with hospital reform, said Lauterbach. With this announcement, Lauterbach surprised the states and representatives of government factions in the Bundestag today.

Due to next year’s federal elections, bills must now be brought quickly to the federal cabinet, explained Michael Weller, head of the “Health, Health Insurance” department at the Federal Ministry of Health (BMG). Anything that cannot be dealt with at first reading in the Bundestag in September or October this year has little chance of being implemented, Weller said. Although he admitted that the planned reform of emergency services was “a big deal,” BMG was well prepared to separate medical services and transportation. It is expected that medical services provided by emergency services may in future be billed at national level through Social Security Code V (SGB V).

O Emergency reform provides for the connection between the 112 control centers and the medical on-call service 116117. Lauterbach announced today that everyone involved should be digitally connected. “We are currently expanding at an accelerated pace the digital architecture required for this,” he said, also with regard to the electronic patient record (ePA). The emergency reform will be supported by the introduction of a national ePA from the beginning of 2025.

It is also important to train community emergency paramedics and be able to provide telemedicine services at all levels. BMG is also working on a solution for pool doctors, Lauterbach explained. There is an exchange here with Federal Labor Minister Hubertus Heil (SPD). Lauterbach was confident that the reform would come into effect in early 2025.

Emergency reform eases pressure on hospitals

Emergency reform is the “calling card” of hospital reform, said Minister Lauterbach. If emergency rooms were no longer so overcrowded and the 30% of people who don’t belong there were relieved of the burden, doctors would feel more comfortable at work again. The head of the government commission for hospitals, Tom Bschor, also emphasized that wisely establishing and structuring emergency care was the key to more efficient care in hospitals. Planned reserve funding, which is expected to be introduced as part of hospital reform, is also best suited to funding structures designed for emergencies that cannot be planned for.

The telemedical network to be able to distribute medical staff more flexibly is also important, Bschor added. He also spoke out in favor of expanding the skills of non-medical staff. “Emergency paramedics can do so much more if you let them.” Furthermore, the current 240 control centers and 300 emergency service areas in Germany are not optimally distributed and configured. If these were replanned, larger areas would be created and the number of control centers would be reduced, Bschor said. In its ninth declaration on the reform of emergency care, the government commission defended the existence of one control center per million inhabitants.

Lauterbach promised that better patient control would be possible through a digitally supported control center that would link the two emergency numbers 112 and 116117, as well as through nationwide intensive care provided by legal health insurance associations (KV) . He knows that the doctors he hires are already under pressure. “Emergency care is not an optional task, but rather mandatory”, emphasized Lauterbach at the direction of the President of the Council of the National Association of Statutory Health Insurance Doctors (KBV), Andreas Gassen. The federal government will therefore require KVs to be involved in emergency care in a systematic and widespread way, Lauterbach confirmed.

Medical profession is already crowded

KV will listen with interest to what they should do in the future, Gassen replied. The legislature could also include 365 Sundays per year in the law, but that would still be difficult to achieve. He warned that KVs did not have “backup doctors in the fridge” who could take over emergency care. You have to get along with the doctors you currently work with. He advocated analyzing the exact needs and existing offerings and checking what functional solutions already exist between KVs and hospitals for emergency care. However, reform laws should not be overburdened, especially given the ongoing reform of outpatient care (Health Care Strengthening Act, GVSG), said Gassen.

Furthermore, additional financial resources are needed to expand the 116117 on-call medical service to 24/7 availability, Gassen further demanded. This cannot be achieved with the fees paid by contracted doctors. The Chairman of the Board of the German Hospital Association (DKG), Gerald Gaß, also highlighted that the many doctor-patient contacts in the outpatient sector could be made more efficient through better structures.

With regard to the federal states, which will initially be bypassed with the procedure announced today by Lauterbach and will only be able to take a position on changes to emergency services in the Federal Council, Lauterbach recognized conflict lines. When it comes to emergency reform, states are “even closer to the federal government’s proposals” than when it comes to hospital reform, he explained today. However, he is aware that reforming emergency services could be difficult. The federal states created their own systems that worked individually, but which should not be continued, Lauterbach said.

Bill medical services via GKV

Emergency services would have to become a service of the statutory health insurance (GKV) and thus be transferred to SGB V, said Lauterbach. A distinction must be made between transportation and medical services provided. It doesn’t make sense if transportation is expensive. At this point he “does not only count on the approval of the states”. It won’t get easier because not only health, but also state interior departments have to be involved in the reform of emergency services, said BMG department head Weller.

The objective is to complete the care on site, without transport to the hospital – if possible, emphasized Bschor. When patients enter the clinic, numerous tests are carried out, which in some cases are not even necessary. These are also costs that could be saved through renovations, explained Bschor.

The Green Party’s healthcare policy spokesman in the Bundestag, Janosch Dahmen, explained that it is actually irrelevant how many laws implement the upcoming healthcare reforms. It is important that these can be implemented before the 2025 elections. It also makes sense to discuss hospital reform, emergency services reform and changes to emergency services in parallel. “Everything is connected to everything else,” Dahmen said. Dahmen was convinced that the reform could help improve care.

Ministers surprised by Lauterbach’s announced procedural change

Schleswig-Holstein’s Health Minister Kerstin von der Decken (CDU) was surprised by Lauterbach’s announcement today. The minister said that she could not spontaneously evaluate this change in procedure. However, she spoke out in favor of federal framework guidelines for reforming emergency care and rescue services. However, she rejected detailed requirements. Countries know best what their respective needs are, von der Decken said. However, von der Decken saw the advantage of taking over emergency services as an independent service area in SGB V of uniform national regulation and the associated cost assumption. However, in Schleswig-Holstein an agreement has already been reached with payers, so this is not necessary.

The Minister of the Interior of Saxony-Anhalt, Tamara Zieschang (CDU), positively assessed the fact that the four major healthcare reforms (hospital reform, emergency reform, emergency services and outpatient care) should be discussed together. However, Zieschang emphasized that she does not believe in the planned transfer of emergency services to SGB V.

He referred to the existing structures on site and the possible resistance that could arise in response to Berlin’s demands. “The district administrator will not allow his control center to be taken away,” Zieschang said. Consequently, it rejects federal requirements regarding emergency services. Instead of a fixed number of control centers, quality requirements should be specified and incentives created, says Zieschang. In Saxony-Anhalt, the 13 existing control centers are currently seeking mergers.

To Karsten Schultze, Chairman of the Board of Trustees ADAC Foundation and President of Technology at ADAC, it is important that renovation projects continue quickly. Emergency services reform and emergency reform should, if possible, take place in parallel. Because there are inefficiencies throughout the rescue chain, says Schultze. However, planned reform approaches are moving in the right direction, she emphasized. ADAC is also ready to contribute its experience to the reform project, Schultze offered. © cmk/aerzteblatt.de

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