A Vision for Improved Home Respiratory Therapy

What is home respiratory therapy?

This refers to non-hospital-based ventilation as well as the provision of oxygen and sleep apnea therapy devices.

What specific services do home care providers offer in the area of respiratory home therapy?

They play a key role in caring for patients with chronic respiratory diseases by providing all the necessary medical devices and technology. It is these non-physician healthcare providers who bring services related to these medical devices directly to patients’ homes and support their therapy in coordination with all professional groups involved in the patient’s care (such as nurses, respiratory therapists, physical therapists
, speech-language pathologists, etc.).

What WILL healthcare ideally look like in the future?

In the future,

• Telemedicine and e-health should be the standard in outpatient care
• Enabling patients to participate more and have a greater say in their care
• Cross-sector collaboration and individualized treatment pathways should be the norm

What political framework conditions must be established to ensure modern, forward-looking healthcare?

1. Give patients a stronger voice!

We support the new federal government’s plans to strengthen the voice of patients in self-governing bodies. Patient organizations should be granted their own full voting rights in the Joint Federal Committee (G-BA)—and thus be directly involved in decisions regarding the provision of assistive devices for home use.

2. Politically recognize assistive technology providers and ensure equal rights!

• Providers of assistive devices must be classified as systemically important and, in the event of a crisis, be granted priority access to protective measures and be reimbursed for the additional costs incurred due to the pandemic
• Equal consideration in legislative proposals or health emergencies
• Granting the right to have a say and to actively participate in the self-governing bodies of the health care system (in particular the G-BA)

3. Consistently advance the digitization of at-home respiratory therapy

• Despite the technical capabilities, no nationwide model has been implemented to date. It is therefore necessary to translate the existing legal provisions into manageable standards
• Create new reimbursement models for the use of digital or telemonitoring-enabled tools and services (such as video consultations, teleconsultations, and telemonitoring)
• Early Connection to the Telematics Infrastructure
• Updating the list of assistive devices and expanding it to include devices with digital components

4. Incorporate the provision of assistive devices in the home into SGB V

Services provided by assistive device providers in the home setting should be enshrined in SGB V as home care services that complement the provision of assistive devices—with the goal of ensuring that patients and insured individuals have a guaranteed entitlement to the provision of assistive devices and related services, which cannot be separated.

5. Create incentives for innovative healthcare alliances and models

• Encourage statutory health insurance plans, through incentives, to jointly develop and implement innovative care models
• Statutory health insurance plans should actively utilize innovative offerings in the field of assistive device provision and communicate these to their insured members (Section 68b, Paragraph 2, SGB V)

6. Take External Factors into Account in Assistive Device Contracts

In order to be able to respond more flexibly in the future to unforeseeable external factors (such as price increases, shortages of raw materials and supplies
, etc.), the contracts—which typically span several years—between health insurance funds and medical device providers should be adapted more flexibly to changes in conditions that arise on short notice. The introduction of a medical aid cost index is recommended as an objective and transparent basis for assessment.

Based on the considerations mentioned above, the target vision is as follows:

»For us, patients and the success of their therapy are at the heart of our services. As a home care provider of respiratory home therapy, our mission is to work in collaboration with patient
organizations, prescribers, nursing staff (where applicable), and payers to ensure needs-based care for chronically ill patients—care that is focused on therapeutic success and cost-effectiveness throughout the
entire duration of therapy. In doing so, the potential of digitalization in respiratory
home therapy should be fully leveraged. We are also committed to ensuring that patients are proactively involved in
decisions regarding their therapy, thereby further increasing their adherence to treatment. “

1. How do you view the role and importance of home care providers in the care of patients with chronic conditions in the field of respiratory home therapy—both now and in the future?

Dr. Alfred Wiater: “Alongside physicians and nurses, home care providers represent the third pillar in the care of patients who require respiratory home therapy. The services that home care providers must deliver to ensure adequate patient care have not yet been sufficiently defined. This requires a standardized catalog of services and a defined certification of qualifications for home care providers.” 

Dr. Jens Geiseler: “Home care providers play an important role in the care of patients with chronic illnesses. Without the provision of oxygen, ventilators, and supplies, as well as a 24-hour emergency service, care would not function. However, I believe that training patients on how to use the equipment and adjust the settings is more the responsibility of the physician or the hospital.”

2. To what extent do you believe that e-health, telemedicine, and telemonitoring can contribute to improving care for patients with chronic conditions in the area of respiratory home therapy?

Dr. Alfred Wiater: “Taking advantage of the opportunities offered by digitalization—including in the field of home respiratory therapy—enables us to improve the quality of care. However, digital medicine, even when using AI, cannot and must not replace personal contact with patients. This applies to medical and nursing care as well as to care provided by home care providers. In addition to establishing digital care structures, it is essential to ensure that the implementation of digital care complies with data protection regulations. Patients must be fully informed about the possible uses of their data before giving their consent to data sharing. Obtaining consent from people whose cognitive functions are impaired—for example, due to age—can be problematic. Appropriate safeguards must be established for these individuals. Furthermore, older people in particular may feel overwhelmed by the technology underlying digitalization. Finally, accessing their stored data can cause stress and anxiety for patients if they misinterpret or misunderstand the information. Precautions must also be taken for these cases.” 

Dr. Jens Geiseler: “Telemedicine and telemonitoring can effectively support the care of patients with chronic conditions and help improve that care. However, this requires that patients be willing to share their treatment data—with hospitals as well as all other relevant stakeholders. In my view, however, the data should be stored at the hospital or in specialized telemedicine centers, rather than with the provider, even if this is more expensive. Storing the data there eliminates the question of jurisdiction and responsibility for the stored data.”

3. Given rapidly rising costs and a growing shortage of skilled workers, how can the quality of care in home respiratory therapy be ensured in the future? How can service providers be supported in this regard? 

Dr. Alfred Wiater: “The appeal of the role of home care providers can be enhanced through a clearly defined job description and performance-based compensation. The goal is to make the transition from being a mere equipment supplier to a qualified home care consultant. Improving the quality of care—especially by leveraging the opportunities offered by digitalization—will only be possible if there are coordinated measures in place, such as case conferences for individual patients that involve the attending physicians, nurses, and home care consultants.”

Dr. Jens Geiseler: “Home care providers will continue to be important and reliable partners in the future, provided they ensure reliable, high-quality, and patient-centered care. In doing so, they make a significant contribution to patients’ well-being and to a model of care that focuses on therapeutic success. I am generally open to the policy demands formulated by SPECTARIS in its vision statement. These should, in principle, be suitable for achieving the outlined vision.”