1. German Status

2. Where are we today? PEN society: DGEM (physicans etc.) German guidelines (update 2013/14) Cooperation with Physician board on education for subspecialty Cooperation about student curriculum on nutrition Joint action of the PEN society with different Professional organizations (BDEM, VDOe, VDD etc.) Advice: Ute Winkler Erlangen WHO action Weak: cooperation with health authorities Weak: cooperation with patient organizations

3. What does sucess look like in 3-5 years? Optimal nutritional care all over Germany in hospitals but also in the out-patient service Generation of solid clinical and economical data within Germany (e.g. via EHES, EHIS) Definition of minimal screening and assessment, and of consequences Nutritional assessment (BMI/scores) must become an obligatory part of physical examination in hospitals and in private practice Documentation of malnutrition must have consequences such as nutritional support which must adequately reimbursed Indicational reimbursement (not budget-limited)

4. Needs (Roadblocks) 1.Structural implementation of Clinical nutrition into German hospitals: including tranfer and follow-through management Political action required to force hospitals to do that (Slovenia went to parlament) 2.High-quality intervention studies and economical studies 3.Defined and sufficient reimbursement of clinical nutrition services: Stakeholder action and strong clinical data required to convince the G-BA board 4.Much stronger innvolvement of patient organizations

5. Key step 1: Involvement of health authorities So far very limited in Germany (bottom-up strategy) More advanced in Slovenia: Cooperation with WHO that helped to influence the authorities of countries requiring support after war (top-down approach) – but: health is not a an EU issue

6. Key step 2: Financial support Germany: Insufficient in many respects Efforts to implement nutrition better into the hospital payment system (DRG system) Combine quality Slovenia: Ministry financed annual action plans Many stakeholders engaged Financing of patient care by insurances: financing exists at present for two years (referral ambulance including nutrition /NST in primary health centers)

7. Key step 3: Others Involvement of media Involvement of patient organizations Raise awareness: convince about nutritional effiacy To define quality standards and patient safety To establish coding for reimbursement Nutrition as part of standard and global care