Specialized outpatient palliative care

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The Specialized outpatient palliative care ( SAPV ) - for children and youth Specialized outpatient pediatric palliative care ( SAPPV ) - Germany is in a performance of the statutory health insurance for seriously ill and dying health insurance. In 2007, the legal basis for entitlement to palliative medical and nursing services was created so that these patients can remain in their home or family environment despite complex treatment needs . This is to meet the wish of many patients to be able to stay in a familiar environment until their death. With SAPV, illness-related crisis situations are dealt with, which would otherwise lead to undesirable and stressful hospital admissions. For this purpose, the service providers must have appropriate training and guarantee 24-hour availability, seven days a week.

The services of the SAPV can only be prescribed and invoiced under certain conditions. The scope and type of services and fees are regulated inconsistently in the individual federal states.

Beneficiaries and service providers

Recipients of palliative care are patients who are suffering from the symptoms of an incurable and foreseeable fatal disease. As long as they are in a home environment, necessary medical treatments are usually provided by the family doctor. Sometimes relatives take care of the care, or they are supported by an outpatient care service .

If the general outpatient palliative care (AAPV) is not sufficient to relieve symptoms, the family doctor can also call in a doctor with the additional training in palliative medicine introduced in 2003 and / or a palliative care team as a SAPV service provider. In the context of palliative care, the aim is to maintain and improve the quality of life and self-determination of the seriously ill as well as to support relatives and trusted persons. Palliative physicians in cooperation with palliative care specialists as well as pharmacists, pastors, physiotherapists and others ensure partial or complete care for the patient. Advisory and coordinating institutions can also provide and bill the relevant services.

Legal basis

The legal basis is Section 37b of Book V of the Social Security Code (SGB V). Further legal bases are the guideline for the regulation of specialized outpatient palliative care of the Federal Joint Committee (GBA) of March 11, 2008 and the recommendations of the National Association of Statutory Health Insurance (GKV) of June 23, 2008.

The SAPV is intended to complement the existing range of contract doctors, hospitals and nursing services. Separate benefit entitlements were formulated for the needs of seriously ill children and adolescents. Although children and adolescents are often predicted to have a longer life expectancy, the requirements for specialized outpatient pediatric palliative care as a crisis intervention are still met.

Specialized care must be prescribed by a doctor. Insured persons are entitled to benefits who suffer from an incurable, progressive disease that limits the patient's life to months, and who also require extensive medical care to be provided on an outpatient or inpatient basis. For this reason, residents of nursing homes or child and youth welfare institutions, among others, are also entitled to SAPV, and in the inpatient hospice , a palliative doctor can be called in on this basis in addition to the family doctor if necessary. Crisis intervention is carried out, especially with children, even if life expectancy is predicted to be longer.

For most of the federal states, model contracts are available as regionally limited, generally applicable agreements between health insurance companies and service providers. They form the basis for the respective individual contracts of the service providers who want to operate within this region. Palliative care teams who have concluded SAPV contracts with the health insurance companies can bill the respective health insurance company for the services. The prerequisites for such a contract are, among other things, the 24-hour availability of the service every day of the week, proven professional qualifications of the employees and the guarantee of certain material equipment, which also includes an " emergency supply of narcotics for unforeseeable, urgent and short-term needs of the patient according to § 5c BtMVV “.

history

Predecessor projects

In 1986, the Oncological Focus Stuttgart was founded in Stuttgart in the form of a BGB society , which employed so-called bridge nurses to coordinate and carry out the home care of seriously ill tumor patients. The first positions for bridge sisters were financed by the Ministry of Social Affairs and the Cancer Association of Baden-Württemberg; bridge maintenance is part of the standard care there.

In 1995 the Long-Term Care Insurance Act was passed, according to which outpatient services are to be given preference over inpatient services. As a result, various other model projects were initiated to provide the seriously ill at home with appropriate care, including Home Care Berlin, the cancer pain initiative in Greifswald and SUPPORT in Göttingen. It has been proven that all model projects contributed to a situational improvement for patients and their relatives and thereby reduced the number of hospital admissions. However, since the financing of the respective models was not continued beyond the project phase, most of them ended after a few years.

Development of palliative care offers

The first legal framework agreements on hospice and palliative care in 1998 concerned inpatient facilities such as hospices and palliative wards . From 2002, outpatient hospice work as psychosocial support for dying seriously ill people and their relatives received a statutory subsidy from the health insurance companies if certain conditions were met, such as B. the management of the service by a coordinator trained in palliative care . With the 2007 health reform and the newly formulated § 37b SGBV, every insured person with particularly complex and difficult care needs could claim specialized palliative care. The legal requirements for the SAPV were supplemented in 2008 by guidelines of the Federal Joint Committee and in 2009 by recommendations of the National Association of Statutory Health Insurance Funds.

Establishment of the SAPV

Up until the end of 2008, very few contracts had been concluded between health insurers and palliative medicine specialists or palliative care services. Instead of the planned EUR 80 million, only EUR 0.54 million was spent. The German Society for Palliative Medicine and the Federal Ministry of Health complained about delays by the health insurance companies; these referred to missing structures. In some cases, patients therefore enforce their legal claims against the health insurance companies before social courts. For the year 2011, the Federal Ministry of Health stated 84.9 million euros as expenditure for medical and nursing services in the SAPV.

As of August 1, 2009, 30 SAPV contracts were concluded nationwide, 65 were being negotiated. There were no contracts in the federal states of Baden-Württemberg, Berlin, Rhineland-Palatinate, Saarland and Saxony. As of June 30, 2010, the number of contracts with corresponding service providers rose to 110, as of December 31, 2010 to 123, as of June 30, 2011 to 154 and as of December 31, 2011 to a total of 176 contracts; Most of the contracts were concluded across all insurance types. As of December 31, 2011, a total of 11 contracts had been negotiated for the care of children and young people. Up to then there were 55 contracts in the ongoing negotiations.

Further differentiations

Since it was found that only about 10-30% of palliative patients require specialized care, put the National Association of Statutory Health Insurance Physicians end of 2010 a proposal for a General Out-patient palliative care (AAPV) before; Almost two years earlier, the German Hospice and Palliative Association and the German Society for Palliative Medicine had published a common definition for AAPV. In 2011, representatives of both associations formed a working group to describe and develop the necessary structures for an AAPV. Then z. B. Doctors and nursing service managers who work in the AAPV have a basic qualification in palliative care .

In the evaluation report of the Federal Joint Committee of 2011, various points of criticism of the SAPV became clear, for example that the concerns of children and young people are not yet adequately taken into account. Here, the service providers suggested an independent, specialized outpatient pediatric palliative care (SAPPV). In addition, a clearer distinction between the SAPV and the AAPV was desired and a binding statement as to the extent to which people with dementia and non-oncological diseases are entitled to SAPV. However, there were also indications that the number of unnecessary drug prescriptions and hospital admissions could be reduced, some of which was attributed to the AAPV.

literature

items

Web links

Individual evidence

  1. ↑ a b Definition of the German Society for Palliative Medicine, at www.dgpalliativmedizin.de , accessed on March 22, 2019
  2. ↑ a b Federal Joint Committee: Guideline on the Ordinance of Specialized Outpatient Palliative Care. Version dated: December 20, 2007, Federal Gazette No. 39 (p. 911) of March 11, 2008 (PDF; 83 kB)
  3. ↑ Framework recommendation of the National Association of Statutory Health Insurance Funds according to §132 d Abs. 2 SGB V for specialized outpatient palliative care from June 23, 2008 in the version of November 5, 2012 (PDF; 36 kB)
  4. ↑ Gisela Klinkhammer, Sabine Rieser: Specialized outpatient palliative care: Finally there are contracts - but not necessarily the right ones. Deutsches Ärzteblatt, vol. 106, issue 24, June 12, 2009
  5. ↑ Recommendations on the SAPV care concept for children and adolescents from June 12, 2013, page 2 , accessed on November 22, 2013
  6. ↑ Specialized outpatient palliative care - patients with no chance of recovery are entitled to care in their own home. Krankenkassen.de, accessed on October 22, 2009
  7. ↑ Regional model contracts SAPV on the website of the German Society for Palliative Medicine, accessed on March 10, 2018
  8. ↑ Framework recommendation of the National Association of Statutory Health Insurance Funds from November 5, 2012, Section 4.4
  9. ^ Preamble to the statutes of the oncological focus Stuttgart  ; accessed on March 22, 2019
  10. ↑ Tasks and goals. Oncological Focus Stuttgart eV ; accessed on March 22, 2019
  11. ^ A b c U. Schmid: Outpatient care and supply. In: Susanne Kränzle, Ulrike Schmid, Christa Seeger (eds.): Palliative Care. Practice, further education, studies. Springer, Berlin 2018, p. 140. ISBN 978-3-662-56150-8
  12. ^ U. Schmid: Outpatient care and supply. In: Susanne Kränzle, Ulrike Schmid, Christa Seeger (eds.): Palliative Care. Practice, further education, studies. Springer, Berlin 2018, p. 141. ISBN 978-3-662-56150-8
  13. ↑ a b Matthias Kamann: Health insurance companies leave the dying in the lurch. Welt Online, October 17, 2008
  14. ↑ Small question from the MPs Birgitt Bender, Elisabeth Scharfenberg, Dr. Harald Terpe, another member of parliament and the BÜNDNIS 90 / DIE GRÜNEN parliamentary group on “Implementation of specialized outpatient palliative care”, BT-Drs. 16/7936; Online (PDF; 103 kB)
  15. ↑ WDR Monitor : Painful Process - Why Palliative Care Is Not Making Progress. ( Memento from February 11, 2009 in the Internet Archive )
  16. ↑ Who can help when healing is impossible? - The struggle to die with dignity - A film by Georg Lolos and Jan Schmitt. ( Memento from October 30, 2009 in the Internet Archive ) WDR The Story
  17. ^ Evaluation report SAPV 2011, p. 6; at www.g-ba.de (PDF; 1.4 MB), accessed on November 22, 2013
  18. ^ Report on the status of SAPV implementation, status September 7, 2009, at www.dhpv.de (PDF; 49 kB), accessed on November 25, 2013
  19. ^ Report to the Federal Ministry of Health on the implementation of the SAPV guideline for 2011, p. 39; at www.g-ba.de (PDF; 1.4 MB), accessed on November 25, 2013
  20. ^ Definition of DGP / DHPV from January 15, 2009 ; accessed on March 22, 2019
  21. ↑ Joint working group APV of the DHPV and the DGP: Working paper on general outpatient palliative care (AAPV). As of April 23, 2013 ; accessed on March 22, 2019
  22. ^ Report to the Federal Ministry of Health on the implementation of the SAPV guideline for 2011, pp. 103-105; at www.g-ba.de (PDF; 1.4 MB), accessed on November 25, 2013