Emergency reform: More efficiency planned with digital networking

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In what is now the third attempt, the Federal Ministry of Health wants to advance the reform of emergency care. According to Federal Health Minister Nina Warken, the law is intended to “form the basis for networked, digital, and standardized emergency care.” The goal is more targeted and economical emergency care through better networking of all service providers. The digitalization of processes plays a major role in this.

Digital networking as a central building block of the reform

Among other things, the 116117 number of the Association of Statutory Health Insurance Physicians (KV) will include an acute control center in addition to the appointment service. The latter is now intended to cooperate more intensively with the emergency number 112 through better digital networking during case handover. This means that people seeking emergency help will no longer have to explain their situation repeatedly but will be directly forwarded to the right place. This is also to be facilitated by access to the electronic patient record (ePA) in emergencies. The 112 will remain the acute emergency number for life-threatening situations.

Furthermore, so-called integrated emergency centers (INZ) are to be established, which are open around the clock and consist of an emergency department of a hospital, a KV emergency practice, and a central initial assessment unit. These are also to be digitally networked with each other and provide initial outpatient care to patients on a nationwide basis. A standardized and digital initial assessment, which is to be established in the long term, plays a central role in this.

Various measures are to be established to increase the survival rate in cases of sudden cardiac arrest. For example, a nationwide, uniform register is to record all publicly accessible defibrillators and be digitally networked with all control centers. First responder apps, which help people nearby with resuscitation, among other things, are also intended to speed up initial care for those affected.

Emergency rooms are to be relieved

In the long term, all of this is intended to relieve the burden on emergency rooms, as fewer people will visit them unnecessarily and will instead receive reliable initial care elsewhere. In addition, medical emergency rescue is to become a statutory health insurance benefit. This will facilitate outpatient care. Previously, paramedics were obliged to take patients to the emergency room instead of treating them on-site, as only the pure travel expenses were reimbursed by health insurance funds. With the new regulation, rescue workers can provide more reliable outpatient care to patients, and there is no risk of them being left with the costs.

Financing of the reform

The digitalization of emergency rescue and networking of control centers will be financed over five years by a federal special fund for infrastructure and climate neutrality (SVIK) with a total of 225 million euros. In the official press conference on the emergency reform, Warken speaks of an expected direct cost saving of 1.2 billion euros and an indirect saving of another billion euros. The latter arises because fewer people are admitted as inpatients. These figures were based on the Finance Commission Health.

Reform elicits mixed reactions

The Green Party's health policy spokesperson in the Bundestag, Janosch Dahmen, praises the further development of digitalization but considers the financing plans to be “unfinished.” Stella Merendino, spokesperson for hospital and emergency care for the Left Party, counters in her statement: “What is being created here is not a functioning system, but a digital labyrinth.” The new reform would further burden the 116117 even more than it already is.

Medical associations such as the Association of General Practitioners or the Professional Association of Pediatricians and Adolescent Physicians evaluate the reform very critically. There is not enough specialized personnel for the realization of an around-the-clock outpatient emergency service, said Klaus Reinhardt, President of the German Medical Association (BÄK), among others. He is critical, among other things, “that continuous availability via the number 116 117 should actually be maintained around the clock […] through corresponding services.” He also considers it confusing that different systems are to exist side-by-side, he said at a press conference in the run-up to the 130th German Medical Assembly and announced a similarly critical statement.

Hospitals also criticize the financing plans. Especially against the backdrop that savings measures in outpatient care were decided as part of the GKV Stabilization Act, but significantly more outpatient care is planned with the new reform, this is unreasonable, explain the three board members of the National Association of Statutory Health Insurance Physicians (KBV), Andreas Gassen, Stephan Hofmeister, and Sibylle Steiner in a joint statement. The CEO of the German Hospital Federation (DKG), Gerald Gaß, emphasizes that a “reform is fundamentally necessary,” but criticizes that the planned reform is unrealistic for most hospitals.

Stefanie Stoff-Ahnis, Deputy CEO of the GKV-Spitzenverband, welcomes according to a press release the “introduction of a standardized digital initial assessment procedure that will guide patients nationwide to the appropriate level of care according to their medical treatment needs.” She praises, among other things, the planned expansion of digital and telemedicine care services, that treatment capacities are to be made more transparent, and thus insured people can expect care more quickly in acute cases.

Representatives of various health insurance associations such as the Verband der Ersatzkassen, the BKK Dachverband (PDF) and the AOK-Bundesverband also welcome the reform in large parts. The BKK Dachverband and the AOK-Bundesverband see a need for improvement in the standardization of initial assessment procedures. There is a need for “a clear, nationwide guideline from the G-BA for control centers and integrated emergency centers (INZ).” The AOK-Bundesverband fears that patient management is “not thought through to the end” and that hospital emergency rooms will be relieved less by the new reform than hoped. The planned savings are also considered “completely unrealistic” by the federal association.

(mki)