1. INTERNATIONAL PRIVATE PHYSICAL THERAPY ASSOCIATION General meeting - SingaporeGeneral meeting - Singapore Sunday 3rd May 2015Sunday 3rd May 2015 Changing towards Evidence BasedChanging towards Evidence Based can becan be one option to improve the income of physiotherapists in Germany 1

2.  National health service in Germany is not a state- operated service  Receiving curative services in the national health service requires a medical prescription R.v. Esebeck 2

3.  Services carried out by PT`s and charged to the national health insurance providers are contained in the so-called cure and medicine guidelines  Out-patient healthcare for patients is primarily carried out by private practioners  The professional association must be involved in the drafting of these guidelines 3 R.v. Esebeck

4.  Physiotherapists receive payment directly from the national health insurance provider  Within the context of self-administration the national health insurance providers sign agreements about remuneration with the professional association  The negotiations are conducted by the professional association 4 R.v. Esebeck

5.  At the moment we have compensation of the achievements per treatment  The whole reimbursement arises from the number of treatments 15 €680 € 5 R.v. Esebeck For example:

6.  Discussion starts now how to establish a new version of the contracts  We still have an insufficient reimbursement for a qualitative care with reference to EBP 6 R.v. Esebeck  In the future we expect a system of case-based lump sums

7. Our task is: - to change the system with the help of the results of evidence-based physiotherapy and to convert the compensation per treatment to a compensation-all- inclusive (case-based lump sums) - to settle an evidence-based physiotherapy-care model 7 R.v. Esebeck

8. The negotiation strategy is to generate saving potentials from the reimbursement volume of the non recommended services and move that to the recommended services. 8 R.v. Esebeck

9. 9 Perhaps we can achieve: - Better quality standards and - increasing remuneration

10. If we create an all-inclusive compensation system for physiotherapy, we need a correct database for the development of the remuneration system with routinely documented information from physiotherapy practices. 10 R.v. Esebeck Requirement:

11. The information in the database shall include diagnoses, investigations and their results also treatment procedures, measurements, goals and justifications. This information shall enable us to determine the expected treatment costs for a case. 11 R.v. Esebeck

12. A first concept for the development of "remuneration packages in physiotherapy" was developed in collaboration with the Centre for Social Policy at the University of Bremen. The discussion about the results has not yet started in our decision-making bodies, but will hopefully start soon. 12 R.v. Esebeck

13. 13 At the same time we started our political campaign … to increase the value of our services. R.v. Esebeck

14. 14 Why 38,7%? The business volume of our practices has to increase with round about 39% for a better compensation of our employees comparable with the employed Physiotherapists in German hospitals or public services.

15. 15 What happened since 2014?  Mobilisation of our members with several action posters, information, events and demonstrations  several calls with members of parliament of every party in our parliament so called ‚Bundestag‘  several calls with members of parliament in the states p.e. Bavarian Parliament

16. 16  Events and discussions with politicians in the course of our General Meeting  a collection of signatures from patients, colleagues and other interested persons to form a request for the people in power, politicians and insurance companies  Result: Over 180.000 signatures within 6 months!

17. 17  We may expect several legislative initiatives to improve our financial terms and conditions  We expect also an appreciable cutback of socalled redtapes, that means bureaucracy  and we expect new competition regulations for our Negotiations with the insurance companies to improve our chances for a fair result of our proceedings Results:

18. 18 And of course unlimited and direct access of our patients to our services.

19. Thank you very much for your attention! 19 R.v. Esebeck