Hospital.Help

Munich – In order to be able to lead the upcoming structural change in the inpatient sector to a defined target image, demand planning for the hospital landscape is necessary. This was shown yesterday at the Bavarian Green Hospital Summit of the Greens in Munich.

“Demand planning is simply part of restructuring a hospital landscape,” said Robert Hinke from Verdi Bayern. “And in Bavaria we don’t have demand planning. We only have a continuation of the status quo.” The hospital landscape will change as a result of the federal hospital reform. And hospital planning at the state level must “become proactive.”

Leonie Sundmacher from the Ludwig Maximilian University in Munich, who is also a member of the government commission for modern and needs-based hospital care, advocated needs planning in the inpatient sector analogous to the outpatient sector. “We have a map that shows the needs,” she said. “We have levels of care that must be met. And we need a target image with which we can define what would be oversupply and undersupply.”

Roland Engehausen of the Bavarian Hospital Association pointed out that hospitals have to finance themselves independently of demand planning. “A state can include a hospital in the hospital plan,” he said. “But that does not mean that this hospital can finance itself within the system.” As long as there is no adequate financing of hospitals, we will have to live with limited planning.

The federal hospital reform aims to reform the financing of hospitals. Part of the revenue is to come from a reserve budget, the amount of which will, however, continue to depend on the number of cases treated.

“We are concerned that the design of the new reserve budget will create even more bureaucracy than we already have,” said Engehausen. “We would need a further development of the non-case-number-related flat rates, such as the various surcharges that already exist today, for example for security houses.”

Municipalities need help

The majority of hospitals are currently in the red, including in Bavaria. Bernd Buckenhofer from the Bavarian Association of Cities stressed that the longer the federal government waits to implement its reform, the greater the deficits will become. “The independent cities and districts have been making up for their hospitals’ deficits for years – initially only to a manageable extent,” reported Buckenhofer. “We said: we can and want to afford it.”

In the meantime, however, the deficits have risen to double-digit millions in some cases. “We believe it is right to expand the DRG system to include provisional financing,” said Buckenhofer. “The problem at the moment is that unfortunately we cannot see in which direction the federal and state governments are now shaping the provisional flat rates.”

Buckenhofer stressed that the municipalities needed help in redesigning the hospital landscape. “Local politicians always want to keep their hospitals,” he stressed. “We are now beginning to discuss the fact that only the best hospitals should remain. But that then leads to every district trying to have the best hospital in its area.”

A mayor of a city with a hospital simply cannot say: “My hospital is superfluous.” And the municipalities also need financial help to restructure the hospital landscape, because restructuring is expensive.

Taking the population with you

One goal of the hospital reform is to increase the quality of inpatient services by linking quality requirements to the respective service groups. “In Germany, there is still the narrative that you are well cared for if there is just a red cross on the hospital,” said Tobias Hermann of AOK Bayern.

“But that is not the case. Medicine is evolving. And for example, to provide good care for heart attack patients, you simply need specialists. We therefore need a new narrative that people are not taken to the nearest hospital where the lights are on, but to the hospital that provides good care for patients.” In the meantime, some emergency doctors no longer take patients to every hospital, but only to the good ones.

Sundmacher from the LMU reported on a conversation with the chief planner of the Danish hospital reform, in which the hospital landscape was radically centralized. “I asked him how he communicated the centralization of the hospital landscape to the population,” she said. “He said that the government had explained to the population that the hospital landscape had to be centralized in order to achieve a better outcome.”

At that time there was an article in British Medical Journal which showed that mortality fell when heart attack patients were transferred to a more suitable hospital. “This meant that the population supported centralization because people knew that they would benefit from the restructuring,” said Sundmacher.

In Germany, there is still room for improvement in terms of quality. “For example, we have a very high rate of interventional cardiology here, but only below-average mortality rates,” said Sundmacher. “In terms of staffing, however, we are well to very well positioned. In that respect, we are actually well prepared for demographic change.”

But at the same time, there is a high workload in Germany because the staff have to deal with many cases. “The recipe would be for us to concentrate on treating the necessary cases and reduce the medically unnecessary cases,” said Sundmacher. “We still have great potential there.” © fos/aerzteblatt.de