Do not overload the outpatient service catalog

05.04.2022 12:40

The inclusion of interventions in a newly defined outpatient service catalog should only be limited to treatments that can “usually” be carried out on an outpatient basis. This is also expressly provided for in Section 115b of the Fifth Social Code (SGB V). A report that has now been published by the IGES Institute, however, suggests that the self-administration should include all interventions that can “in principle” be carried out on an outpatient basis. This would almost double the size of the AOP catalog.

Prof. Dr. Dr. H.-J.-Meyer, President of the BDC says: “The Professional Association of German Surgeons (BDC) welcomes the legislature's initiative to promote outpatient care in the healthcare system. However, we reject an expansion of the outpatient service catalog to this extent.” This exceeds the legal mandate and would also involve an unmanageable amount of testing in the inpatient area.

“The crucial question also remains unanswered, namely whether the treatment of a patient in an individual case is suitable for an outpatient procedure,” adds the Vice President of the BDC, Dr. YES. Rüggeberg. Criteria are listed for a so-called context check, but overall they remain too vague. “The need for clinics to carry out an operation on an inpatient basis can lead to bureaucratic burdens and conflicts,” says Rüggeberg. Furthermore, the German health system is not prepared in terms of infrastructure for such a wave of outpatients. Last but not least, there is a lack of nursing capacity for postoperative care of patients at home.

For complex cross-sector services that are currently often provided in an inpatient setting, the structural requirements could be reflected by remuneration via so-called “hybrid DRGs”. You could start with a few but frequent interventions: In Great Britain, in 1990, 20 sector-specific services for same-day interventions were initially identified with the aim of increasing efficiency. In addition to a broad medical consensus, the criteria were the frequency of the interventions and the fact that the services were previously mainly provided in inpatient settings.

The traffic light coalition's contract already refers to the hybrid DRGs. Such a mixed calculation of DRG and uniform assessment standard (EBM) should, in addition to maintenance costs, also cover a short inpatient stay of up to three days. It would be up to the respective service provider to estimate the length of stay for each individual patient, without any justification or verification being required.

H.-J. Meyer also refers to another completely ignored aspect that concerns further training: Outpatient procedures according to Section 115b SGB V require specialist status and will therefore no longer be accessible to training assistants. “The self-administration should now first identify all procedures that are usually performed on an outpatient basis and transfer them to the AOP catalog. The BDC - together with the medical societies - is happy to support the review of the IGES's first proposal as to which interventions we should actually transfer to outpatient care," says Meyer.