As of: February 15, 2024, 10:00 a.m
By: Jonas Napiletzki
Comments
Press
Split
Reliant on care – but how much?
This is assessed by an expert from the medical service.
But his reports are not always correct.
© Jens Kalaene/dpa
The VdK district association advises those in need of care and relatives to take a closer look when assigning the level of care.
Not every decision has to be accepted.
District
– What the medical service is repeatedly accused of across the region also applies, from the perspective of the social association VdK, to reports in the district: “We have found that the level of care is very often incorrectly assessed,” says Kristian Müller, district manager of the social association, to ours Newspaper.
“Across Bavaria, we are successful with one in four objections and one in two lawsuits that we bring forward.”
Last year, the district association held 281 consultations, filed 43 objections and filed 16 lawsuits.
Overall, the numbers are even higher, says Müller, pointing out that the VdK is not involved in all contradictions.
To classify this, the social lawyer adds: “The success rate is very high compared to other areas of law.” He does not want to assume that the medical service, which prepares the reports on behalf of the nursing care funds, is intentional.
“But the experts are sometimes way wrong,” says Müller – and gives various reasons that he has identified for this.
VdK criticizes telephone reports and errors
One of these is telephone reports, which are increasingly being carried out by the Bavarian Medical Service (MDB) during the corona pandemic and also afterwards.
Instead of a personal visit, those in need of care answer questions on the receiver.
“These reports are sometimes very flawed,” says Müller.
The MDB can choose the telephone option at its own discretion.
Kristian Müller, VdK district manager.
© arp
But the social association also sometimes receives astonished feedback from on-site experts that the employees only briefly looked at their laptops.
“Sure – the employees answer many questions for themselves when they go in.” But later it often turns out that the experts have forgotten care-related diagnoses.
As an example, Müller explains: "If someone has two knee prostheses and can hardly walk up stairs, but the report says 'it is possible to climb stairs independently', then something is wrong." Cases like these are reflected in statistics nationwide, as was recently the case in a response from the federal government to a request from the left-wing MP Ates Gürpinar from the Rosenheim district: This shows that objections to initial reports and further reports from the Federal Medical Service (MD Bund) have been successful in almost 30 percent of the cases in the past four years.
The number refers to those cases in which an objection was previously lodged - which, according to statistics, was the case nationwide in around seven percent of all reports prepared by the MD Bund.
Medical service classifies numbers
In contrast to the almost 30 percent nationwide, contradictions at the Bavarian Medical Service (MDB) were recently successful in “only 21 percent of cases in the sense that the level of care was corrected because it already existed in the preliminary assessment,” the MDB reports Name of the CEO Claudia Wöhler upon request.
According to the MDB, the proportion of reports against which an objection was lodged was 7.6 percent in 2023 - “despite the continuously growing order volume”.
The MDB calculates that this results in a proportion of 1.6 percent of all applications against which objections were successful.
My news
The community is gradually losing patience: Gasthof zur Post in Schliersee has been empty for years
2 hours ago
Criticism of the Schlierseer Hof now also comes from the Heimatpflege-Vereinlesen
More beds with an experience character: What should pimp tourism in the Miesbach district read
“Can only be positive”: Prominent supporters advertise Schlierseer Hof-Neubaulese in a video
The number of alarms is increasing: Irschenberg fire department will record more operations in 2023
Start of the festive season reading
Expressed in absolute numbers, this means: Of the 406,808 MDB statements, 30,980 were objected to.
Of these, 6,533 were successful.
“The statement 'very often' is generalizing and misleading because absolute numbers are not used here,” criticizes Wöhler.
Nationwide, the proportion of objection reports is between six and eight percent, confirms the CEO.
“In every second objection report, the level of care that has already been determined is confirmed.” In 20 percent, the need for care changed between the assessment and the objection.
And in almost every third objection report, a different level of care is determined.
“The reason for this is often that not all relevant information was available at the time of the previous assessment,” says Wöhler.
+++ Read also: Level of care often rated too low - how to avoid the typical mistakes +++
Regarding the causes suspected by Müller - telephone assessments and forgotten diagnoses - Wöhler explains: "As a result of the Care Support and Relief Act, assessments by telephone are possible from January of this year with considerable limitations." This form has already been chosen from 2020 to 2022 because of the risk of infection been.
But: The experts “have the know-how,” emphasizes Wöhler.
Home visits are a given for initial applications and children in need of care.
The most common reasons for later approvals are a lack of information at the time of the assessment, explains the MDB.
Patients would rarely give incorrect or overly positive information about their own physical condition.
However, Wöhler admits in the MDB's answer: "It can also happen that information is overlooked by the expert." nap
This is how an objection process works
If patients want to apply for a
nursing level
, they can do so informally at the
nursing insurance fund
, explains Kristian Müller, district manager of the VdK.
The nursing care fund accepts the application and commissions the
Bavarian Medical Service
(MDB) to
assess
the applicant.
The MDB then proposes an appointment at which an expert can get
an idea
- by telephone or on site .
“The report is then sent to the nursing care insurance fund, which issues a decision
on this basis
and sends it to the applicant.”
Anyone who does not agree to this must hurry up: patients have one month to file a
timely objection
.
“That’s tight – the mail often gets left behind, especially for those in need of care,” says Müller.
Once the objection has been sent, those in need of care should seek advice - for example from a
lawyer
or the
VdK
.
“Our task is to provide valid reasons for the objection - for example with
statements
from doctors, relatives and the patients.” Family doctors are often asked who know the people in need of care and all their
previous illnesses
from treatment, some of which have been carried out over many years.
Current
medical records
are also relevant.
“These are very important in order to check the diagnoses for completeness and to find out the severity of the diseases.”
The reasons for the objection
are then
sent to the nursing care fund, which has several options: Either the fund examines the matter again and commissions a
second report
from the MDB or it passes the objection on to the nursing care fund's
objection committee
, which decides whether the objection should be accepted rejected or granted.
Based on this decision, the nursing care fund issues an
objection notice
.
From now on there is another month to
file
a complaint
with the
social court if in doubt.
“The objection should be well-founded before it is dealt with in the courts.” This is often the case, says the VdK district manager.
“It would be worthwhile for many people
to take a closer look
and not accept the decision.” nap
You will receive a selection of all the important stories from your region in our free newsletter regularly and directly by email.
Register here for Tegernsee, here for Miesbach and here for Holzkirchen.