The dialogue partners
Prof. Dr. Patrick Da-Cruz is Professor of Business Administration and Healthcare Management at the Faculty of Healthcare Management at Neu-Ulm University of Applied Sciences (HNU) and Academic Director of the MBA programme Leadership and Management in Healthcare.
Before joining the HNU, Mr Da-Cruz worked for well-known strategy consultancies in the pharmaceutical/healthcare sector and in management positions in companies in the healthcare industry in Germany and abroad.
Dr. Matthias Brachmann has been working as a consultant for companies and hospitals for more than ten years. After studying international economics in Tübingen, Kyoto and Ann Arbor, he completed his doctorate at the University of Witten/Herdecke. At the end of 2013, he founded bcmed for strategic consulting for players in the healthcare sector. Prior to this, he was managing partner of a well-known hospital consultancy for several years. Dr Brachmann is a faculty member of the International Emergency Department Leadership Institute (Boston, USA) and a lecturer in hospital finance at Witten/Herdecke University. He has also been a member of the Professional Committee of the European Society for Emergency Medicine since 2013. He is an active reviewer for several international health economics and medical journals.
![[Translate to English:] Dr. Matthias Brachmann](/fileadmin/_processed_/4/1/csm_240205%20Dr.%20Brachmann_f331558f49.jpg)
Dr Brachmann, you are Managing Director of bcmed GmbH in Ulm. What is bcmed's business model and what role does the "emergency care" sector play for you and your company?
Dr Matthias Brachmann: First of all, we are a traditional consultancy in the healthcare sector. We work on a project basis throughout Germany, mainly for hospitals, but our clients also include associations and organisations as well as industry. bcmed stands for business consulting and management of emergency departments and the organisation of emergency care is our core business. Since emergency and scheduled patients compete for the same scarce resource - medical and nursing care - the organisation of care for one group cannot be thought of without the other.
The German healthcare system is generally characterised by a considerable need for reform. What about emergency care in this context?
Dr Matthias Brachmann: Very little has happened in emergency care in recent years. Unfortunately, this applies to the entire rescue chain, from lay assistance, control centres and rescue services to the medical on-call service and hospital emergency departments. Each area in itself has a considerable need for reform. But it is not called the rescue chain for nothing. The areas are all interconnected and reform must always be considered and implemented across all areas. Otherwise the problems will only be shifted. Poor GP care, for example, leads to a considerable additional burden for ambulance services, emergency practices and emergency departments.
What health policy challenges does emergency care in Germany face and how does this compare with the health systems of other neighbouring countries?
Dr Matthias Brachmann: The most important challenge is demographic change in all its facets. Longer life expectancy means that acute and emergency care systems are increasingly being called upon to provide geriatric care. At the same time, the retirement of the "boomers" (baby boomer generation; editor's note) from the labour market is causing an enormous shortage of specialists, which is leading to even scarcer personnel resources and, due to the resulting lack of regular care structures (decline in GP practices), is putting even more pressure on acute and emergency medicine. The order of the day is therefore to direct the flow of patients to the right levels of care and to work as efficiently as possible there. Digitalisation can make an important contribution in both areas!
Our European neighbours are way ahead of us here. Whereas in Germany, anyone seeking help with cold symptoms immediately consults a doctor or even a hospital, in the UK the first step is a telephone or telemedical consultation. Only 10% of those seeking help then need to see a doctor in person. In Lower Austria, the rescue coordination centre and medical on-call service are in the same hands: the people calling for help are asked questions based on an algorithm and the appropriate care structure is recommended. The electronic health card can be used to track whether the patient actually went to this unit. In Romania, all smaller emergency departments are connected to emergency centres via telemedicine. The doctors working in these centres can intervene in shock room care and provide support with their specialist expertise. And this has been the case for over ten years!
In addition, a separate speciality has developed abroad for the care of acute and emergency patients: emergency medicine. However, the medical profession in Germany is not yet in favour of the introduction of a specialist in emergency medicine.
In this context, what influence will the hospital reform planned for 2024 have on the further development of emergency care?
Dr Matthias Brachmann: The impact is substantial and starts with the level 1 hospitals. The difference between the outpatient 1i hospitals and the fully-fledged 1n hospitals is precisely their participation in inpatient emergency care. If a hospital does not fulfil the requirements for emergency care, it is transferred to 1i status. As this reform step means that some hospitals will no longer participate in inpatient emergency care, but the number of patients requiring emergency treatment will not decrease, the remaining hospitals must expect a further increase in emergency patients and prepare themselves accordingly in terms of staffing and space.
Does the new hospital reform essentially mean an upgrading of the emergency structures offered to date or what structural policy measures are actually needed?
Dr Matthias Brachmann: The Hospital Transparency Act, which has not yet been passed by the Mediation Committee, mentions a service group called "emergency medicine". If this service group actually comes into effect, the emergency services provided by hospitals in Germany will become transparent for the first time. After all, despite a recent pandemic, we will not know in 2023 how many patients are treated in emergency departments each year. Not to mention how patients were treated, whether they waited a long time and how much their care cost. The measurability of performance alone provides an important basis for improvements.
The G-BA decision on tiered emergency care and the Medical Service's review of the requirements specified therein have made a significant contribution to improving emergency structures. Some of the requirements are somewhat outdated and qualitative aspects still play a subordinate role. An update of the resolution would further enhance the inpatient emergency structures.
In terms of structural policy, there are two issues in particular that should be tackled quickly: better interlinking of emergency departments and emergency practices, whose equipment and structures should also be standardised, on the one hand, and end-to-end digitalisation of the rescue chain on the other. There is a lot of catching up to do here!
What is/will remain your biggest reform wish for the year 2024, which has just begun?
Dr Matthias Brachmann: My greatest wish is that there will be a reform at all. At the moment, the political players don't seem to be pulling in the same direction. However, patients as well as hospitals and other stakeholders in emergency care need structural changes. And this needs to happen now, not after the next general election.
Thank you very much for the interview!
