Evaluation and further training are part of it.
05.08.2010 13:24
The German Society for Surgery welcomes the sensible use of outpatient surgery.
More than two-thirds of surgical procedures in Germany are now performed on an outpatient basis rather than as inpatients. When indicated, the advantages for patients and the potential cost savings are undeniable. The German Society for Surgery (DGCH) points out that for each individual patient, the decision of whether to operate in a hospital or a private practice must be carefully considered and based solely on medical, not financial, criteria. The same criteria apply to the qualifications of surgeons. This, in turn, leads to increased challenges for continuing medical education. This responsibility can no longer rest solely with hospitals.
The German Society of Surgery (DGCH) is referring to statements made by the German Hospital Federation, the Professional Association of Practicing Surgeons (BNC), and the German Association of Specialist Physicians (DFV) regarding the cost-saving potential of outpatient surgery. "We welcome the dedicated work of highly qualified practicing surgeons as well as that of their colleagues in hospitals," says Professor Dr. Hartwig Bauer, Secretary General of the DGCH. The crucial question regarding outpatient surgery is not which procedure can be performed on an outpatient basis, but rather which patient is suitable for it.
Studies confirm the high quality of outpatient surgery. Its potential to reduce costs is also undisputed. However, the German Society of Surgery (DGCH) questions whether the savings will reach hundreds of millions of euros annually: Different patient demographics and risk profiles would have to be considered depending on the indication. Professor Bauer argues that blanket accusations of primarily profit-driven inpatient surgery are just as unjustified as accusations of patient selection and expanded indications in the outpatient sector.
The only decisive factor is the quality of care for patients. Regarding processes, for example, outpatient surgery clinics could learn a great deal from their colleagues in private practice. "With the increasing shift of procedures that were previously performed exclusively on an inpatient basis to the outpatient setting, one of the major challenges in the future will be to adequately qualify surgeons for this during their postgraduate training," says Professor Bauer. If a large number of operations can no longer be offered at hospitals, the consequence should not be to perform them on an inpatient basis.
Every effort must be made to ensure that postgraduate training is not offered exclusively in hospitals, as has been the case until now, but also in private practices. Under the current reimbursement models, this pressing problem cannot be solved. In addition to joint efforts by surgeons in both hospitals and private practices, we need adequate financing models for postgraduate training. One conceivable approach for surgery in private practice would be a concept similar to the lump-sum funding in general medicine.
According to the German Society of Surgery (DGCH), outpatient surgery is a special form of surgical care. Therefore, it is just as important to ensure quality and scientifically support outpatient procedures as it is to inpatient care. The DGCH's Surgical Working Group on Outpatient Surgery (CAAO) sees it as its responsibility to play a more active role in this area. This means, in particular, initiating, supporting, and evaluating scientific studies. "We need to put an end to mutual accusations, misjudging the realities of care, inappropriate referral practices, and pointless turf wars between private practices and hospitals. There is far too much that can only be achieved through collaboration," summarizes Professor Bauer.