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Background: The restructuring of the course of patient treatment supported by the German Social Accident Insurance (DGUV) was executed in two steps. Durchgangsarzt /H-doctors: On 1 January 2011 new requirements became effective regulating the participation of physicians in the Durchgangsarztverfahren-a special procedure regulating the treatment process for occupational accidents. The new requirements for the first time define a gradation of medical qualifications and the tasks of these specialized physicians. The DGUV and the Federation of Public Health Insurance-Contracted Doctors agreed to abandon the previous procedure involving so called H-doctors by 31 December 2015. Effective 1 January 2016 there will only be the Durchgangsarztverfahren with regard to out-patient medical care for persons injured in an occupational accident. In-patient medical treatment: In a second step the in-patient medical treatment was restructured. This measure went into effect on 1 January 2013. The existing VAV Injury Classification Procedure was modified and the treatment of the severely injured (SAV) and the in-patient treatment by specialized doctors (DAV) were introduced. SAV started as planned on 1 January 2014 with nationwide 73 certified hospitals, thus ensuring comprehensive medical care. However, some of the hospitals, including some BG clinics, currently do not fully meet the necessary requirements. [ABSTRACT FROM AUTHOR]

Economic effects of the revised VAV: The effects of the reform of the injury type procedure (VAV) are demonstrated using the example of a rural specialized care clinic (400 beds). Using a retrospective analysis of 114 inpatient VAV cases from the clinic in the year 2012, 11 patients were identified who should have been transferred to an appropriate maximum care clinic according to the new criteria for the severe injury type procedure (SAV). The cost analysis of these 11 cases resulted in a turnover volume of 113,714.97 Euros. From an economic perspective, such a decline in turnover without a reduction of the contingency costs and at the same time increased requirements of the new VAV (e.g. hygiene), must be considered a negative development. Effect of the revised VAV on expertise: The loss or transfer of interesting trauma surgery cases (as a rule multiple trauma cases) could lead to a reduction in medical expertise in the department and in addition there is the problem with future acquisition of the next generation of trauma surgeons. It is feared that the advanced training to specialist trauma surgeon in VAV hospitals will be made more difficult or take longer in the future which will be a clear disadvantage for VAV clinics for attracting the ever decreasing numbers of next generation surgeons. Conclusion: In Germany as a whole there is extensive SAV competence in VAV clinics. This is of course not true for all clinics and for all regions but to a varied extent in the different locations. That this excellent expertise in VAV clinics will be compromised by bureaucratic regulations and which will therefore be detrimental for the patients is, from the author's point of view, taking things too far. In synopsis, the expectations of the author are subdued with respect to the reform of inpatient healthcare procedures from the perspective of a senior consultant in a VAV clinic. In the sense of the best possible care of patients, it would have been desirable if more attention had been paid in the reform to the actual competence of the individual VAV clinics. [ABSTRACT FROM AUTHOR]