Specialized Out-Patient Palliative Care (SAPV) in Germany Contracts and Experiences

Contracts for specialized out-patient palliative care (SAPV) have been negotiated between health funds and palliative care providers in Germany since 2007. Currently model contracts exist in all regions, the majority has been disclosed. Since significant differences in the terms of these contracts may lead to differences in palliative care provision we studied the contracts to provide a basis for a national evaluation of SAPV. Method The contracts were comparatively analyzed in regard to patients entitled to benefit from SAPV, team structure demanded in the contract, models of care provision, cooperation between specialized care providers and other health care professionals (e.g. general practitioners, social workers), quality control and documentation strategy as well as reimbursement. To reveal the impact of the contracts semi-structured inter-viewswere carried out on 22 palliative care teams (PCTs) to assess team structure, organization and work flow and deployed documentation systems. Outcome The model contracts differ remarkably. SAPV may be provided as counseling, coordination of care, additive partial care provision and full care provision by the specialized providers. There is no sufficient definition of the respective terms in the contracts, resulting in discrimination being mostly determined by the mode of reimbursement. Palliative care providers cooperate with general practitioners, home care nurses and hospice services, less with professionals working in the psycho-social field (e.g. spiritual care, socialwork, psychologists). Regulations for documentation differ strongly, ranging from no specification on required documentation at all to extensive forms. Given substantially different payment models service reimbursement is barely comparable. Conclusion SAPV contracts may influence care provision and differences complicate comparisons, thus a national evaluation of SAPV quality is urgently needed. Such a study should assess palliative patient demands and SAPV service quality.