SURVEY: GP-2025/4: BMC

1. Health Care Strengthening Act (GVSG)
From the BMC's perspective, the draft Health Care Strengthening Act (GVSG) lacked a clear strategic vision and remained vague in many areas. While innovative approaches such as health regions, case and care management, and primary care centers were discussed in draft bills, these concepts were not included in the draft bill. Against this background, we advocated for the discussed concepts of primary care centers and health regions to be reinstated in the draft bill and supported the corresponding recommendations submitted by the Federal Council on June 19, 2024, to amend the bill. These approaches are crucial for advancing the structural development of local healthcare and meeting the demands of a changing healthcare landscape.
In our view, the following points must be taken up again:
• Introduction of primary care centers: As a new operating model for multi-professional, cooperative, and coordinated primary care, municipalities should be able to initiate provider-independent primary care centers, not only in underserved regions. These centers should at least include primary care and the services planned under the KHVVG in cross-sectoral care facilities and be integrated into a regional care network. This represents a forward-looking step toward strengthening regional healthcare and ensuring regional, cross-sectoral care.

• Care and case management: A key element of regionally and cross-sectorally networked care is also the management of patients and the coordination of necessary healthcare services through care and case management (patient guides). The additional reimbursement for these services from the EBM, as found in previous drafts of the GVSG, is appropriate for this purpose.
• Introduction of health regions: The introduction of health regions aims to create regional networks that improve cross-sectoral cooperation in healthcare and address local needs. Regional networking and cross-sectoral cooperation are key to better healthcare.

2. Nursing Competence Act (PKG)
The promotion of preventative measures, the greater involvement of volunteers, and low-threshold support services are important steps to ensure the security of care. The desired expansion of the medical skills of nurses, which should relieve the burden on medical staff and enable more efficient, patient-centered care, was also positively highlighted. Despite these steps in the right direction, however, further action was still needed. The regulations for the transfer of medical tasks to nurses still required individual doctor-specific transfer, and the options for assuming medical services were not yet sufficiently extensive. The restriction imposed by individual doctor-specific transfer is not necessary as long as the skills concerned are original nursing and therapeutic skills that meet international standards. As a result, the regulation in the PKG had the potential to relieve the burden on medical staff and limited the autonomy of nurses.

In our view, the following points must be taken up again:
• Fast track and simplified proof of benefit for DiPA: The BMC also supports the simplified proof of benefit and the introduction of the fast track for DiPA, as this will also enable digital applications in the market and thus in everyday care. Digital applications can contribute significantly to stabilizing home care and must be integrated into everyday care.
• Recommendations for nursing aids and medical devices: As part of their service provision, nurses should be able to make specific recommendations regarding the provision of nursing aids and medical devices, the necessity and requirement of which is assumed under certain conditions. The Federal Association of Nursing Insurance Funds will establish guidelines by the end of 2025 that regulate the qualification level of nurses, the recommended medical devices and the application process. The BMC fundamentally supports strengthening the role of nurses and advocates for clear regulations on the transfer of medical tasks. This strengthens the independence of the nursing profession and promotes the quality of care, as nurses close to patients can make needs-based recommendations. This development is a positive step towards greater responsibility for nurses. At the same time, it must be ensured that the recommendations are
sufficient qualified nursing staff to continue to ensure the quality of care.
• Regional networks: To improve the care and support of those in need of care and their families, €20 million should be made available annually from the long-term care insurance equalization fund for regional networks and a national office should be set up to promote structured cooperation in regional networks. The BMC welcomes the promotion of cooperation in regional networks as they have the potential to significantly improve the care of those in need of care and their families. In addition to stronger networking, they promote patient-centered care, particularly through cooperation between doctors, volunteers, nursing services, pharmacies and other relevant institutions and people. In addition, population-specific health needs can be addressed through regional adaptation of care. In addition to coordination across different service providers and locations, the integration of all support and health-oriented services - medical, nursing, therapeutic, social services, among others - is necessary.
• Delegation of medical services: The authority of nurses should be expanded by allowing them to independently provide medical services and issue prescriptions for home care, provided they have the appropriate qualifications. The BMC fundamentally welcomes the greater involvement of nurses in healthcare, particularly through the delegation and independent performance of expanded medical tasks. This helps to ensure the provision of care, relieves the burden on medical staff, and increases flexibility in care, for example when nurses administer vaccinations. The autonomy of nurses is strengthened and their role in healthcare is enhanced. At the same time, multi-professional collaboration between nurses and other professional groups is promoted, which supports efficient and patient-centered care.

3. Healthy Heart Act (GHG)
From the BMC's perspective, the measures contained in the draft bill for the further development of structured treatment programs (DMPs) represent a step in the right direction. However, they were not sufficient. From the BMC's perspective, further steps are needed, particularly regarding digital documentation and data transmission, further administrative simplifications, and the possibility of providing care for multimorbid patients within the framework of DMPs.

In our view, the following points must be taken up again:
• Strengthening DMPs: The Federal Joint Committee (G-BA) should be commissioned to adopt a DMP guideline for the cross-disease care of patients at increased risk of developing cardiovascular disease. The current approval of DMP contracts by the Federal Social Security Office (BAS) should be abolished. Furthermore, the G-BA should establish quality targets according to which quality-based reimbursement should be made for DMPs for types 1 and 2 diabetes mellitus and coronary heart disease. Requirements for DMP training should be specified. Health insurance funds should be required to offer their insureds DMPs for which the G-BA has adopted requirements and to conclude contracts with the associations of statutory health insurance physicians to this end.
From the BMC's perspective, continuous treatment of chronically ill patients is a crucial key to reducing the strain on the healthcare system and counteracting the progression of diseases. In particular, the coordinated care process offers the opportunity to improve the care of chronically ill patients, reduce their risk of death, and improve the overall
To reduce treatment costs. Therefore, the BMC supports the goal of strengthening DMPs and further increasing their impact on healthcare. However, the BMC is critical of the abolition of the DMP program fee, which would recklessly sacrifice positive incentives for the dissemination of DMPs.