A multitude of topics occupied the delegates in Stuttgart Effects of the Statutory Health Insurance Care Strengthening Act, inappropriate fee decisions, psychosocial care for refugees and the reform of training.
The praise to the board of the Federal Chamber of Psychotherapists (BPtK) came from qualified mouth. He was deeply impressed by what had been achieved in the last few months, commented Prof. Dr. phil. Rainer Richter presented the report of the BPtK board at the 27th German Psychotherapist Day on November 14th in Stuttgart. After ten years as President of the Chamber, Richter did not run again this spring and now took part in the event as President of the Hamburg Chamber of Psychotherapists.
Still under the shock of the terrorist attacks in Paris the night before, the German Psychotherapist Day (DPT) thought of the victims of the attacks with minute's silence that morning; It was not so easy to go back to the agenda afterwards - under the impression of what had just happened.
Implementation of the GKV-VSG
The President of the Federal Chamber of Psychotherapists, Dr. rer. nat. Dipl.-Psych. Dietrich Munz, presented the results of the board's work in the past months to the delegates. The GKV-VSG (GKV-VSG), which came into force in July, and its implementation was focus of professional policy. "It took lot of effort to convince politicians that the care of mentally ill people must be the subject of the law," said Munz. Now, however, the Federal Joint Committee (G-BA) and the GKV-VSG have been commissioned to adopt regulations in the psychotherapy guideline to make the range of therapies more flexible. This includes regulations for psychotherapeutic consultation hours, early diagnostic work-up, acute care and relapse prevention as well as the promotion of group therapies and the simplification of the assessment process.
For Munz, it is now important to convince and with factual suggestions for making psychotherapy more flexible thus to advance the decision-making process in the Federal Joint Committee in the interests of the psychotherapists. The willingness of the BPtK to constructively contribute to the implementation of the legal requirements will not be lacking, provided that an agreement can be expected with regard to the remuneration.
A multitude of topics occupied the delegates in Stuttgart Effects of the Statutory Health Insurance Care Strengthening Act, inappropriate fee decisions, psychosocial care for refugees and the reform of training.
The praise to the board of the Federal Chamber of Psychotherapists (BPtK) came from qualified mouth. He was deeply impressed by what had been achieved in the last few months, commented Prof. Dr. phil. Rainer Richter presented the report of the BPtK board at the 27th German Psychotherapist Day on November 14th in Stuttgart. After ten years as President of the Chamber, Richter did not run again this spring and now took part in the event as President of the Hamburg Chamber of Psychotherapists.
Still under the shock of the terrorist attacks in Paris the night before, the German Psychotherapist Day (DPT) thought of the victims of the attacks with minute's silence that morning; It was not so easy to go back to the agenda afterwards - under the impression of what had just happened.
Implementation of the GKV-VSG
The President of the Federal Chamber of Psychotherapists, Dr. rer. nat. Dipl.-Psych. Dietrich Munz, presented the results of the board's work in the past months to the delegates. The GKV-VSG (GKV-VSG), which came into force in July, and its implementation was focus of professional policy. "It took lot of effort to convince politicians that the care of mentally ill people must be the subject of the law," said Munz. Now, however, the Federal Joint Committee (G-BA) and the GKV-VSG have been commissioned to adopt regulations in the psychotherapy guideline to make the range of therapies more flexible. This includes regulations for psychotherapeutic consultation hours, early diagnostic work-up, acute care and relapse prevention as well as the promotion of group therapies and the simplification of the assessment process.
For Munz, it is now important to convince and with factual suggestions for making psychotherapy more flexible thus to advance the decision-making process in the Federal Joint Committee in the interests of the psychotherapists. The willingness of the BPtK to constructively contribute to the implementation of the legal requirements will not be lacking, provided that an agreement can be expected with regard to the remuneration.In the current coordination phase, feedback from the individual chambers of the federal states is welcome, said Munz later in the discussion about his activity report. At the moment, it is also about putting stop to substitution ideas, which are definitely there with health insurance companies. "There are plans for psychotherapeutic consultation hours without the involvement of psychological psychotherapists."
With the lifting of the restrictions on powers in the GKV-VSG, the psychotherapists have achieved further success in professional policy, emphasized the BPtK President. According to the GKV-VSG, psychotherapists are now authorized to prescribe services for psychotherapeutic rehabilitation, hospital treatment, patient transport and sociotherapy. Here, too, the G-BA should implement the legal requirements in its guidelines. It is now important, stressed Munz, to ensure that the relevant ideas of the BPtK are included in the negotiations of the responsible G-BA subcommittee on "Induced services". Munz is hoping for the support of the doctors represented there. “They actually know that the psychotherapists have these competencies to prescribe services.” However, he is aware that there are also fears among doctors that they will face competition in this way. At the same time, Munz is certain “that the majority of doctors recognize the need for the new regulation”. In addition, the health insurance companies have already made it clear that they would watch with eagle eyes how the service expenditures develop.
With regard to the increase in psychotherapeutic fees, Munz sees the negotiation options now exhausted. The BPtK asked the Federal Ministry of Health to object to the decision of the Extended Evaluation Committee of July 22, according to which the remuneration for psychotherapeutic services requiring approval is increased by 2.7 percent. "Health insurance companies and associations of statutory health insurance physicians have done everything to systematically reduce the appropriate amount of the remuneration," emphasized the BPtK President. The decision of the extended evaluation committee is not compatible with the letters of the law and not with the established case law of the Federal Social Court. In resolution, the delegates called for an end to the “arbitrariness of psychotherapeutic fees” (box).
More staff in the clinics
The BPtK president dealt with this in more detail in his remarks the personnel situation in the inpatient facilities and demanded more binding force in terms of personnel requirements from the legislature. Almost everywhere the standards of the Psychiatry Personnel Ordinance (Psych-PV) are clearly undercut.In the current coordination phase, feedback from the individual chambers of the federal states is welcome, said Munz later in the discussion about his activity report. At the moment, it is also about putting stop to substitution ideas, which are definitely there with health insurance companies. "There are plans for psychotherapeutic consultation hours without the involvement of psychological psychotherapists."
With the lifting of the restrictions on powers in the GKV-VSG, the psychotherapists have achieved further success in professional policy, emphasized the BPtK President. According to the GKV-VSG, psychotherapists are now authorized to prescribe services for psychotherapeutic rehabilitation, hospital treatment, patient transport and sociotherapy. Here, too, the G-BA should implement the legal requirements in its guidelines. It is now important, stressed Munz, to ensure that the relevant ideas of the BPtK are included in the negotiations of the responsible G-BA subcommittee on "Induced services". Munz is hoping for the support of the doctors represented there. “They actually know that the psychotherapists have these competencies to prescribe services.” However, he is aware that there are also fears among doctors that they will face competition in this way. At the same time, Munz is certain “that the majority of doctors recognize the need for the new regulation”. In addition, the health insurance companies have already made it clear that they would watch with eagle eyes how the service expenditures develop.
With regard to the increase in psychotherapeutic fees, Munz sees the negotiation options now exhausted. The BPtK asked the Federal Ministry of Health to object to the decision of the Extended Evaluation Committee of July 22, according to which the remuneration for psychotherapeutic services requiring approval is increased by 2.7 percent. "Health insurance companies and associations of statutory health insurance physicians have done everything to systematically reduce the appropriate amount of the remuneration," emphasized the BPtK President. The decision of the extended evaluation committee is not compatible with the letters of the law and not with the established case law of the Federal Social Court. In resolution, the delegates called for an end to the “arbitrariness of psychotherapeutic fees” (box).
More staff in the clinics
The BPtK president dealt with this in more detail in his remarks the personnel situation in the inpatient facilities and demanded more binding force in terms of personnel requirements from the legislature. Almost everywhere the standards of the Psychiatry Personnel Ordinance (Psych-PV) are clearly undercut.In any case, the personnel specifications made there would no longer correspond to the personnel key required according to the current state of knowledge for guideline-based supply. In the area of nursing in particular, there is dramatic undersupply. In resolution passed on this matter, health policy is requested to end the shortage of staff in the psychiatric and psychosomatic clinics (box).
Alternative concept unsuitable
The further development of the flat-rate remuneration system for psychiatry and Psychosomatics (PEPP) will be an important task of the Federal Chamber of Psychotherapists in the near future, stressed Munz. The Chamber does not consider the alternative concept presented by PEPP critics to be suitable for ensuring guideline-compliant care in all facilities. Munz explained that they had proposed their own concept for the further development of PEPP, kind of hybrid system consisting of performance-based remuneration and hospital-specific surcharges for special structural costs , to: “We need them as specialists for working with war refugees.” Many of the refugees who are now arriving would probably only receive psychotherapeutic treatment later, in the best case they would then have sufficient knowledge of German. "I know that working with interpreters can influence the therapeutic alliance," says Altpeter. The Minister of Social Affairs welcomes the initiative of the BPtK and the German Medical Association for model project to improve the care of mentally ill refugees. The model project aims to ensure and structure care with three modules - building nationwide pool of language mediators, coordination office with qualified experts in each federal state, and qualification of doctors and psychotherapists (see PP, issue 11).
"The refugees first need roof over their heads and then medical care," said Munz. “And I refuse to differentiate between care for physical illnesses and mental illnesses.” Too often the latter is dismissed as less serious. On the basis of around 800,000 refugees who come each year, the President expects around 80,000 refugees who will take advantage of psychotherapeutic care. "For adequate care, including interpreting services, you need around 250 million euros year," said Munz.In any case, the personnel specifications made there would no longer correspond to the personnel key required according to the current state of knowledge for guideline-based supply. In the area of nursing in particular, there is dramatic undersupply. In resolution passed on this matter, health policy is requested to end the shortage of staff in the psychiatric and psychosomatic clinics (box).
Alternative concept unsuitable
The further development of the flat-rate remuneration system for psychiatry and Psychosomatics (PEPP) will be an important task of the Federal Chamber of Psychotherapists in the near future, stressed Munz. The Chamber does not consider the alternative concept presented by PEPP critics to be suitable for ensuring guideline-compliant care in all facilities. Munz explained that they had proposed their own concept for the further development of PEPP, kind of hybrid system consisting of performance-based remuneration and hospital-specific surcharges for special structural costs , to: “We need them as specialists for working with war refugees.” Many of the refugees who are now arriving would probably only receive psychotherapeutic treatment later, in the best case they would then have sufficient knowledge of German. "I know that working with interpreters can influence the therapeutic alliance," says Altpeter. The Minister of Social Affairs welcomes the initiative of the BPtK and the German Medical Association for model project to improve the care of mentally ill refugees. The model project aims to ensure and structure care with three modules - building nationwide pool of language mediators, coordination office with qualified experts in each federal state, and qualification of doctors and psychotherapists (see PP, issue 11).
"The refugees first need roof over their heads and then medical care," said Munz. “And I refuse to differentiate between care for physical illnesses and mental illnesses.” Too often the latter is dismissed as less serious. On the basis of around 800,000 refugees who come each year, the President expects around 80,000 refugees who will take advantage of psychotherapeutic care. "For adequate care, including interpreting services, you need around 250 million euros year," said Munz.He also hopes that the “Building pool of language mediators” module of the model project can be financed from the innovation fund. With the help of this fund, which is part of the Federal Joint Committee, new forms of care are to be developed.
The BPtK President also pointed out "small success" to the delegates: with the reform of the asylum law at the end of October, the admissions committees of statutory health insurance associations and Health insurance companies have been obliged to empower more psychotherapists and doctors specifically to treat traumatized refugees. Anni Michelmann, delegate from North Rhine-Westphalia (NRW), pointed out that this unfortunately does not always work in practice: the applications of two psychotherapists for authorization were rejected in the admissions committee of the Bonn district office. "Colleagues experienced in caring for traumatized people - that is incomprehensible," she criticized. In resolution, the delegates described the authorization of additional psychotherapists as "first necessary step that should be implemented quickly" (box).
The reform of psychotherapist training, which was repeatedly discussed controversially at previous psychotherapist days, was brief this time and treated constructively. A look back: The 25th DPT 2014 in Munich approved far-reaching reform of the training, which provides for university degree in psychotherapy with license to practice medicine (direct training) and subsequent multi-year advanced training to acquire specialist knowledge. The Federal Ministry of Health (BMG) also followed this line. "The BMG has announced that it intends to present key reform issues in 2015", reported President Munz. The BPtK is involved in this process with technical advice and launched the “Project Transition” in January of this year. This project aims to clarify the details of reformed training and further education in transparent process with the participation of the profession. Proposals for both the “competence-based training goals of an approbation course” and the key points of course have already been developed by the BPtK in cooperation with the regional chambers and professional associations in the Transition project. "We have already come long way," emphasized Munz.
Baden-Württemberg's Minister of Social Affairs, Altpeter, had previously demanded in her welcoming speech that specialization should not start too early and should only follow holistic overview. Practical experience in the course is very important.He also hopes that the “Building pool of language mediators” module of the model project can be financed from the innovation fund. With the help of this fund, which is part of the Federal Joint Committee, new forms of care are to be developed.
The BPtK President also pointed out "small success" to the delegates: with the reform of the asylum law at the end of October, the admissions committees of statutory health insurance associations and Health insurance companies have been obliged to empower more psychotherapists and doctors specifically to treat traumatized refugees. Anni Michelmann, delegate from North Rhine-Westphalia (NRW), pointed out that this unfortunately does not always work in practice: the applications of two psychotherapists for authorization were rejected in the admissions committee of the Bonn district office. "Colleagues experienced in caring for traumatized people - that is incomprehensible," she criticized. In resolution, the delegates described the authorization of additional psychotherapists as "first necessary step that should be implemented quickly" (box).
The reform of psychotherapist training, which was repeatedly discussed controversially at previous psychotherapist days, was brief this time and treated constructively. A look back: The 25th DPT 2014 in Munich approved far-reaching reform of the training, which provides for university degree in psychotherapy with license to practice medicine (direct training) and subsequent multi-year advanced training to acquire specialist knowledge. The Federal Ministry of Health (BMG) also followed this line. "The BMG has announced that it intends to present key reform issues in 2015", reported President Munz. The BPtK is involved in this process with technical advice and launched the “Project Transition” in January of this year. This project aims to clarify the details of reformed training and further education in transparent process with the participation of the profession. Proposals for both the “competence-based training goals of an approbation course” and the key points of course have already been developed by the BPtK in cooperation with the regional chambers and professional associations in the Transition project. "We have already come long way," emphasized Munz.
Baden-Württemberg's Minister of Social Affairs, Altpeter, had previously demanded in her welcoming speech that specialization should not start too early and should only follow holistic overview. Practical experience in the course is very important.“At the end of the psychotherapy course, the license to practice medicine should be available, because we need an alignment with the medical course.” The state examination as degree is guarantee for consistently high qualification of the graduates. "The framework conditions must be negotiated by government agencies and practitioners together," said Altpeter. The further training regulations should also be adapted to those of the other health professions.
The Federal Chamber of Psychotherapists was asked by the BMG to indicate how the profession envisions future further training, reported Munz. So far it looks like this: The further training should last five years, two years of which in the inpatient area and two years in the outpatient area. Like the doctors, the psychotherapists should receive standard salary during this time. So far, the BPtK assumes that around 2,500 training places are required.
The delegates welcomed the work of the federal psychotherapists to reform training. "For me that represents tremendous professionalization," said Dr. Heike Winter, Hesse. "I think it's good that the whole process is very transparent," emphasized Günter Ruggaber, Baden-Württemberg. It is important, however, that the BPtK ensures that there are federal legal requirements for funding. "The financing must be negotiated," demanded Anni Michelmann, North Rhine-Westphalia - both for the direct study and for the advanced training facilities and teaching therapies. The former President of the BPtK, Richter, sees it differently: "We have always said: first the content and then the financing - we have to maintain this course." Manfred Thielen, delegate from Berlin, demanded that the "minimum requirements" recently worked out by twelve associations for the reform of training (see following article) be incorporated into the training goals and key points. Barbara Lubisch, North Rhine-Westphalia, finally pointed out that we should be moderate: "We need the skills as goals that you need at the beginning of your career and not those with which you retire." Federal Chamber President Munz accepted the delegates' contributions as approval opposed to continuing the transition process.
The upcoming 28th German Psychotherapist Day will take place on April 23, 2016 in Berlin.
Petra Bühring, Thomas Gerst
Resolutions of the 27th Psychotherapists' Day *
End arbitrariness in psychotherapeutic fees
The 27th German Psychotherapist Day (DPT) calls on health policy to end the systematic discrimination against psychotherapists by health insurance companies and associations of statutory health insurance physicians. Their incomes remained below the average of the other groups of doctors.“At the end of the psychotherapy course, the license to practice medicine should be available, because we need an alignment with the medical course.” The state examination as degree is guarantee for consistently high qualification of the graduates. "The framework conditions must be negotiated by government agencies and practitioners together," said Altpeter. The further training regulations should also be adapted to those of the other health professions.
The Federal Chamber of Psychotherapists was asked by the BMG to indicate how the profession envisions future further training, reported Munz. So far it looks like this: The further training should last five years, two years of which in the inpatient area and two years in the outpatient area. Like the doctors, the psychotherapists should receive standard salary during this time. So far, the BPtK assumes that around 2,500 training places are required.
The delegates welcomed the work of the federal psychotherapists to reform training. "For me that represents tremendous professionalization," said Dr. Heike Winter, Hesse. "I think it's good that the whole process is very transparent," emphasized Günter Ruggaber, Baden-Württemberg. It is important, however, that the BPtK ensures that there are federal legal requirements for funding. "The financing must be negotiated," demanded Anni Michelmann, North Rhine-Westphalia - both for the direct study and for the advanced training facilities and teaching therapies. The former President of the BPtK, Richter, sees it differently: "We have always said: first the content and then the financing - we have to maintain this course." Manfred Thielen, delegate from Berlin, demanded that the "minimum requirements" recently worked out by twelve associations for the reform of training (see following article) be incorporated into the training goals and key points. Barbara Lubisch, North Rhine-Westphalia, finally pointed out that we should be moderate: "We need the skills as goals that you need at the beginning of your career and not those with which you retire." Federal Chamber President Munz accepted the delegates' contributions as approval opposed to continuing the transition process.
The upcoming 28th German Psychotherapist Day will take place on April 23, 2016 in Berlin.
Petra Bühring, Thomas Gerst
Resolutions of the 27th Psychotherapists' Day *
End arbitrariness in psychotherapeutic fees
The 27th German Psychotherapist Day (DPT) calls on health policy to end the systematic discrimination against psychotherapists by health insurance companies and associations of statutory health insurance physicians. Their incomes remained below the average of the other groups of doctors.In addition, significant proportion of the psychotherapeutic services, namely the services that do not require approval, are not taken into account in the fee increases. The delegates demand clear guidelines from the legislature as to the criteria according to which psychotherapeutic fees should be checked and adjusted. "It cannot be that psychotherapists are systematically paid less than other service providers."
Sufficient staff for inpatient care
The delegates criticize that it is there is lack of staff in psychiatric and psychosomatic clinics, especially in nursing. The situation in child and adolescent psychiatry is particularly dramatic. In addition, the Psychiatry Personnel Ordinance does not reflect the personnel key required according to the current state of knowledge, in particular for guideline-based treatment with psychotherapy. That is why the professions of psychological psychotherapists and child and adolescent psychotherapists are to be made mandatory in inpatient care.
The 27th DPT calls on the Federal Joint Committee to quickly process the order already received for the development of contemporary personnel standards; the health insurances should be encouraged to provide the necessary financial resources.
Ensure psychotherapeutic care for refugees
The DPT welcomes the introduction of the health card for refugees in four federal states and demands the same for the other states.
Furthermore, the delegates consider the assumption of costs for interpreting and language mediation services by the health insurance companies to be urgently necessary.
Low-threshold offers for refugees are necessary in order to identify and treat mental disorders at an early stage. The DPT suggests setting up psychosocial consultation hours in initial reception facilities and refugee shelters for diagnostic assessment, initial consultation and crisis intervention. The volunteer helpers there also needed advice and supervision. Furthermore, additional psychotherapeutic offers for unaccompanied minor refugees are needed in cooperation with youth welfare.
* Abridged version by the editorial team
More women in the committees
"The higher the hierarchical position of the committees, the fewer women can be found there, ”said Andrea Mrazek, President of the East German Chamber of Psychotherapists (OPK).In addition, significant proportion of the psychotherapeutic services, namely the services that do not require approval, are not taken into account in the fee increases. The delegates demand clear guidelines from the legislature as to the criteria according to which psychotherapeutic fees should be checked and adjusted. "It cannot be that psychotherapists are systematically paid less than other service providers."
Sufficient staff for inpatient care
The delegates criticize that it is there is lack of staff in psychiatric and psychosomatic clinics, especially in nursing. The situation in child and adolescent psychiatry is particularly dramatic. In addition, the Psychiatry Personnel Ordinance does not reflect the personnel key required according to the current state of knowledge, in particular for guideline-based treatment with psychotherapy. That is why the professions of psychological psychotherapists and child and adolescent psychotherapists are to be made mandatory in inpatient care.
The 27th DPT calls on the Federal Joint Committee to quickly process the order already received for the development of contemporary personnel standards; the health insurances should be encouraged to provide the necessary financial resources.
Ensure psychotherapeutic care for refugees
The DPT welcomes the introduction of the health card for refugees in four federal states and demands the same for the other states.
Furthermore, the delegates consider the assumption of costs for interpreting and language mediation services by the health insurance companies to be urgently necessary.
Low-threshold offers for refugees are necessary in order to identify and treat mental disorders at an early stage. The DPT suggests setting up psychosocial consultation hours in initial reception facilities and refugee shelters for diagnostic assessment, initial consultation and crisis intervention. The volunteer helpers there also needed advice and supervision. Furthermore, additional psychotherapeutic offers for unaccompanied minor refugees are needed in cooperation with youth welfare.
* Abridged version by the editorial team
More women in the committees
"The higher the hierarchical position of the committees, the fewer women can be found there, ”said Andrea Mrazek, President of the East German Chamber of Psychotherapists (OPK).In psychotherapy in general, the proportion of women is 70 percent, among the delegates there are 41 percent, in the state chamber boards 30 percent and on the board of the Federal Chamber of Psychotherapists (BPtK) Andrea Benecke is alone among four men.
Together with colleagues Mrazek has therefore submitted an application with which the BPtK board is commissioned to develop concept that counteracts the "increasing gap". How can you motivate more women to get involved? Which structures hinder engagement? These questions should be discussed at the next DPT, not without first obtaining scientific expertise as to why women come up against “the glass ceiling”.
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