Following protests by affected persons and their relatives in intensive care, Federal Health Minister Jens Spahn has revised his draft bill on the Intensive Care and Rehabilitation Strengthening Act. According to this draft, it is to come into force and be implemented in the summer of 2020. 19,000 cases of outpatient and 3,400 cases of inpatient intensive care are affected by the revised law and its effects. The costs in this area of health care amounted to 1.9 billion euros in 2019. The new law is intended to guarantee better care for patients who need to be ventilated. In addition, it is important to eliminate false incentives, i.e. patients should not be ventilated longer than necessary. In addition, the self-determination of patients is to be strengthened, because they are allowed to decide in which environment they need to be cared for. Accordingly, care can then be provided in the patient’s own home environment, but also in care facilities and special intensive care living units. A specially qualified physician decides on this form of extra-hospital intensive care. These doctors are also responsible for determining the medical necessity of a geriatric rehabilitation measure. Health insurance companies must submit to this decision by the doctor. 20 outpatient treatment days or three weeks of inpatient treatment must be paid for by health insurance companies. However, if the patient then chooses a rehabilitation facility other than the one allocated by the insurance company, additional costs will be incurred by the patient, but these will be halved after the implementation of the reform. This should strengthen the patients‘ right to choose. The Federal Joint Committee (G-BA) will set the framework for uniform quality requirements. According to this, a personal assessment of the quality of the accommodation must also be carried out, which the Medical Service of the health insurance funds must guarantee annually. Only quality-tested care services with quality specifications for care in the home environment will then be considered for out-of-hospital intensive care so that black sheep in the industry will no longer have a chance. Health insurance companies will have to bear the majority of the costs for the accommodation of patients requiring intensive care. Even if extra-clinical care is no longer necessary because the state of health has improved, cost coverage must be offered. Spahn also wants to enforce attempts to wean patients who are to be ventilated by means of additional reimbursements before discharge from hospital, while deductions will be made for omitted attempts. This is to ensure that at least attempts are made when moving to outpatient care so that false financial incentives do not lead to an unnecessary continuation of artificial respiration. The law will also lay down uniform guidelines for the remuneration of nursing staff, as will a number of other quality framework conditions.
