The G-BA's initial assessment guidelines must be suspended and revised!

01.08.2023 14:27

Following the decision of the Federal Joint Committee (G-BA) on an initial version of the directive for the initial assessment of the care needs in emergency care, the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) is writing an open letter to Federal Health Minister Lauterbach and all health ministers of the federal states, to prevent this version from coming into force. The initial assessment guidelines still require fundamental revision, says the letter, which was sent by email and post to the 17 recipients on July 25th.

“In the current reform process, we see the synchronization of political decisions as the only way to make our health system sustainable, sensible and practice-oriented,” emphasizes DIVI President Prof. Felix Walcher, Director of the Clinic for Trauma Surgery at the University Hospital Magdeburg. “So we call on the G-BA and BMG to jointly revise the path we have taken and to place it in the context of the comprehensive, very complex hospital reform!”

The DIVI lists five specific points of criticism - in order to provide direct recommendations for improving the care of emergency patients. One of the criticisms is that the initial assessment guideline focuses on relieving the burden on emergency rooms through patient control in the outpatient care sector of the Association of Statutory Health Insurance Physicians (KV), a sector that is also known to be overloaded, as well as patients after work or commuting accidents, private patients and self-payers - around one Quarter of emergency patients – excluded.

There is high potential for improvement in the initial assessment guidelines

The fact that the G-BA resolution stipulates that from 2027 onwards the initial assessment in the emergency room will only be carried out by certified nursing staff with additional qualifications in emergency care or by emergency paramedics is, for the DIVI, in contrast to previously practiced and scientifically well-validated concepts. “In principle, we welcome the requirement to have qualified nursing staff with additional qualifications in emergency care available around the clock to provide emergency care,” says Dr. Bernadett Erdmann, spokesperson for the DIVI emergency documentation section. However, the head doctor of the emergency room at the Wolfsburg Clinic is skeptical as to whether a sufficiently high number of qualified specialists will be available even after the end of the transition period.

“And even if we do, we need these highly qualified employees primarily to care for patients and not get caught up in administrative processes,” says Prof. Dr. Martin Möckel, as a member of the DIVI Section Structures in Clinical Acute and Emergency Medicine, reported what was reported to the medical director of emergency and acute medicine at the central emergency departments of the Charité Mitte and the Virchow Klinikum in Berlin in response to the G-BA decision . “Clear irritation, considerable criticism and shaking of the head,” summarize Erdmann and Möckel.
Special regulations for the provision of a specialist are required

The initial assessment guideline also stipulates that if there is any uncertainty about patient management in the outpatient sector, a specialist with additional qualifications in clinical acute and emergency medicine must be available at all times to initiate and document the transfer. DIVI is convinced that this cannot be implemented in many places.

“We therefore propose that the provision of a specialist with additional qualifications in clinical acute and emergency medicine is not based on the requirement for the transfer of non-urgent patients to the KV care sector, but rather on the G-BA requirements for the tiered system of emergency structures in hospitals is measured,” explains Dr. Torben Brod, spokesman for the DIVI Section Structures in Clinical Acute and Emergency Medicine and Medical Director of the Central Emergency Room at the Hannover Medical School. “The issue of remuneration for this specialist medical assessment, which is often equivalent to initial treatment, also requires urgent regulation,” notes Brod.

Significant additional administrative effort without any discernible benefit

In summary, in the opinion of DIVI, the emergency departments in Germany will be burdened with additional, unquantifiable administrative workload as a result of the G-BA guidelines presented. “There is neither a clear added value nor a possible improvement in acute care or needs-based control of emergency patients,” says DIVI President Walcher.

Since the G-BA directive comes into force immediately after no objection from the Federal Ministry of Health and subsequent publication in the Federal Gazette, DIVI is now relying on Health Minister Lauterbach and the health ministers of the federal states: “We demand the immediate suspension of the current procedure and a revision of the G -BA decision of July 6th, 2023!”