HISTORY OF THE EMERGENCY PRACTICE STUTTGART
The idea of an emergency practice in Stuttgart is as old as the topic of emergency practices in the entire Federal Republic of Germany.
The fact that it was not created until 1996 may have to do not least with the proverbial Swabian thoroughness with which new tasks and projects are approached in this region. However, this thoroughness has resulted in a model emergency practice whose degree of networking between outpatient and inpatient medicine is still described as exemplary even today.
The necessity of such a body was clear to practising doctors in Stuttgart already by the end of the 1980s: the so-called “assurance mandate“, which every practising doctor has, includes outpatient care for the population at any time of day or night.
There was indeed a home visit service at night and at weekends to care for the seriously ill or patients unable to walk. However, a vacuum arose because all Stuttgart hospital outpatient services were being visited by patients able to walk during the times practices were closed. On the one hand, this meant that outpatient services were very busy providing expensive medical and non-medical staff, while on the other hand, there was a greater number of unfiltered inpatient admissions, which contributed to the ballooning of the much more cost-intensive inpatient treatments.
There were initial thoughts about establishing an emergency practice not based in the hospital. This failed on account of space problems and start-up funding. Half-way affordable rental rooms in central Stuttgart were impossible to find, and the equipment, even just the X-ray machine, would have been completely beyond the possibilities of the doctors. Furthermore, these rooms would have been empty during the daytime on weekdays – a completely uneconomical situation.
At the beginning of the 1990s, when the call for outpatient-inpatient dovetailing grew louder, there were serious thoughts in Stuttgart from around 1994 about cooperation with a hospital. Discussions to this effect, and then negotiations, were conducted with various Stuttgart hospitals, but despite tough talks they did not achieve their objective. There were arguments about the amount of rental payments, lost revenue due to the loss of emergency patients etc., etc.
Finally, in summer 1995, the Marienhospital declared itself prepared to take part in a cooperation with the practising doctors without significant financial advance payments or maintenance payments. Both sides were supported by a pleasingly constructive attitude on the part of the AOK BW, which, in the meantime followed by other health insurance companies, offered to pay for services rendered outside of budget at a fixed value.
The "Notfallpraxis Stuttgart e.V." association (Emergency Practice Stuttgart) was then created. The legal form "association" offers several benefits, including admission to non-profit status and non-assessment of various types of tax.
Practising doctors are elected to the Board of the association by the KVBW (Association of Statutory Health Insurance Physicians in Baden-Württemberg) and the Stuttgart medical profession. Furthermore, the Board always includes a representative of the Marienhospital. Between the Emergency Practice and the legal entity of the Marienhospital, a cooperation agreement was then worked out, on the basis of which the operation of the Emergency Practice would take place in the outpatient rooms of the hospital.
The operating times are established as from 19.00-7.00 on weekdays and around the clock at weekends and on public holidays; the service of the practising doctors is set from 19.00 to 1.00 in the morning, and doctors from the hospital are on duty from 1.00 to 7.00 in the morning. This applies for internists/general practitioners and surgeons/orthopaedists. Regulations differ for ENT specialists and gynaecologists.
The remuneration of the hospital for services rendered, in particular X-rays, is also regulated in the agreement. The non-medical staff of the Emergency Practice, i.e. the specialised medical employees, occupy a certain hybrid position in our arrangement. On the one hand, they do not work at the hospital but exclusively for the Emergency Practice, but on the other hand, they are employed by the Marienhospital in accordance with the AvR – whereby, however, all costs incurred are reimbursed by the Emergency Practice. The reasons for all of this are exclusively of a practical and organisational character.
With the creation of the Emergency Practice Stuttgart, the demand for increased efficiency and minimised costs at the outpatient-inpatient intersection was satisfied. The high number of patients and great acceptance among the population are evidence that the model is a success.