Intersectoral care: sector-linking approaches or ashifting of the sector boundary

Abstract

The coalition agreement between the German Social Democratic Party (SPD), Alliance 90/The Greens (Bündnis 90/Die Grünen), and the Free Democratic Party (FDP) states: "In order to promote the outpatientization of services that have so far been unnecessarily provided as inpatient care, we will swiftly implement sectoral remuneration for suitable services by means of so-called hybrid DRGs" (DRG, diagnosis-related group). More details are not known as yet. At this stage, another reform is surpassing the expectations that must inevitably arise from the coalition agreement, not least and especially for the care of internal medical conditions: The reform of Section 115b of BookV of the German Social Code (SGBV) and, thus, the revision of the catalog of operations that can be performed on an outpatient basis and interventions that can be performed on an inpatient basis. New additions to the catalog include inpatient-replacing treatments, which will likely move internal medicine into the center alongside surgical services. Following publication of the IGES report pursuant to Section 115b (1a) of SGBV and its initial assessments by the organizations involved, it is clear that there may be amixture of the two reform approaches. It is for this reason that the umbrella organization of specialists in Germany (Spitzenverband Fachärzte Deutschlands e.V., SpiFa) already joined the discussion with its own considerations 2years ago. It is essentially irrelevant to patients whether they are treated on an outpatient or an inpatient basis, and they are not interested in whether the physician treating them works in ahospital, apractice, or amedical care center. The main thing is that the physician is qualified, care is provided according to modern evidence-based standards, and there is competent emergency and complication management. This applies to all surgical services and especially to all conservative and interventional services in internal medicine. With these basic considerations in mind, the SpiFa and its associations have discussed aconcept that, in the spirit of the coalition agreement on the establishment of acare concept under the catchword "Hybrid-DRG", stands on its own, avoids sectoral boundaries, but can also be integrated into the considerations on §115b SGBV and necessarily goes beyond the boundaries of the catalog.