“Absurdly many” interventions are still being carried out in hospitals, notes Kassenärzte boss Gassen. He warns that the hospital reform will fail. But the move has also been criticized.
If a major operation is necessary, you go to the hospital – right? The head of the National Association of Statutory Health Insurance Physicians (KBV), Andreas Gassen, is pushing for more options for interventions in practices without an extra overnight stay in the clinic. “A turnaround is necessary,” he told the “Bild”.
“There are still far too many inpatient treatments in Germany.” Out of a total of around 16 million clinical treatments a year, up to four million could be provided on an outpatient basis, i.e. also by resident doctors. Criticism of the initiative came from patient advocates and hospitals. More “day treatments” in clinics are already in the focus of politics.
Gassen cited hernia and joint operations as examples of more outpatient surgeries. In the future, they could work in such a way that patients come in the morning and are taken home after the operation in the afternoon.
There is also an advantage for patients: “They can go back to their usual surroundings immediately after the procedure, which also reduces infections caused by dangerous hospital germs, among other things.” In general, practitioners can also perform certain procedures in hospitals or in smaller surgical centers.
First reactions
The hospital industry reacted negatively to the idea of more surgeries in practices. “The proposal sounds good, but it is completely unrealistic,” said the head of the German Hospital Society, Gerald Gass, of the “Bild”.
Even today, those with statutory health insurance have to wait many months, sometimes well over half a year, for appointments with a specialist. “We don’t want to imagine how this situation would get any worse if millions of patients from the hospitals had to wait for outpatient surgeries in the doctor’s office.”
The statutory health insurance companies generally consider it sensible to shift more operations to the outpatient area, as the central association explained. However, there are of course limits – if special aftercare or equipment is required for complications, an operation must be carried out in the hospital.
Last but not least, the advantage of operations in outpatient facilities is the lower costs, because the comprehensive hospital infrastructure does not have to be financed there. In hospitals, 6.4 million inpatient cases with surgery can be expected for 2021, explained the health insurance association. There were 1.55 million outpatient surgeries in clinics and 5.8 million in practices.
The German Foundation for Patient Protection responded to the KBV’s initiative: “Aftercare or complications must then also be dealt with by the resident doctors.” Board member Eugen Brysch warned, however, with a view to often overloaded practices: “The National Association of Statutory Health Insurance Physicians should first ensure that its members can be reached. At the moment, this is not the case across the country.” When patients got through on the phone, they expected queues.
elective interventions conceivable
According to the Federal Association for Outpatient Surgery, around six million operations are performed on an outpatient basis every year – two thirds of them in outpatient practices, outpatient surgical centers or so-called practice clinics.
“You could actually double the numbers,” said President Christian Deindl of the German Press Agency. There is demand from patients. However, the interventions would not be sufficiently paid for in comparison to an operation with an inpatient stay. “That’s why the clinics were initially delayed and then only started to a small extent with outpatient surgery and the majority said goodbye to it very quickly.”
According to Deindl, numerous interventions – if they are not emergencies or difficult, complex operations – can be performed on an outpatient basis as so-called elective interventions: for example operations on the eye, partial tonsil removal or operations after an inguinal hernia. Outpatient interventions are possible in many specialist areas.
As the head of a pediatric surgery practice for many years, Deindl performed a number of outpatient surgeries himself. From a professional point of view, established staff are in no way inferior to those in a clinic. As a rule, an operating surgeon, a surgical specialist, a medical specialist, an anesthetist and a medical specialist with experience in anesthesia are involved in an outpatient operation. Not least for children and old people, it has a positive influence on recovery if they can quickly return home to their familiar surroundings after the operation.
Hospital reform by 2024
A law passed by Federal Health Minister Karl Lauterbach (SPD) already aims to make certain clinical examinations possible without an overnight stay and to be billed by hospitals – with the consent of the patient. This should create more capacity for the scarce nursing staff during the day when there are fewer night shifts to fill.
However, patients should rather stay in the hospital if overnight care at home is not guaranteed. The law is also intended to remove incentives that lead to higher-remunerated hospital stays, although it would also work on an outpatient basis and without accommodation. For certain treatments, therefore, a “sector-equal” remuneration should be determined, which lies between the outpatient and inpatient level.
The FDP health expert Andrew Ullmann said: “The potential for outpatient operations in the private sector is proven to exist.” It must be remembered that, unlike clinics, practices do not receive any money from the federal states, but have to make investments themselves. Basically, a stronger division of labor is one of the goals of the planned hospital reform.
However, the thrust is also a concentration on a smaller group of particularly qualified clinics. A federal government commission recently estimated the chances of success with artificial joints: If only special clinics replaced hips, 397 new surgeries could become unnecessary each year.
Source: Stern
I have been working in the news industry for over 6 years, first as a reporter and now as an editor. I have covered politics extensively, and my work has appeared in major newspapers and online news outlets around the world. In addition to my writing, I also contribute regularly to 24 Hours World.
