Hospital.Help

Nuremberg – An amendment based on the hospital reform is to be introduced into the Medical Research Act (MFG). This is proposed in an amendment submitted to the German Medical Journal This approach has been met with considerable criticism from both the medical profession and the hospitals.

Currently, it is already planned that hospitals must submit quarterly data on the number of beds and intensive care beds set up as well as the number of doctors employed to the Institute for the Hospital Remuneration System (InEK). This transmission was first required by law on January 15, 2024. This regulation was introduced with the Hospital Transparency Act.

In an initial draft of the Hospital Transparency Act from August 2023, it was planned that hospitals would have to report not only the number of doctors, but also the service groups including assigned treatment cases on a quarterly basis. However, according to the law that has come into force, the reporting of service groups is no longer required every quarter, but only annually. In addition, it was previously provided for independently of the number of doctors.

Now, due to an amendment to the MFG, the quarterly data transmission of the number of employed hospital doctors is also to be broken down according to the planned service groups. The hospital reform, which, like the MFG, is currently in the parliamentary process, provides for the introduction of 65 nationwide, uniform service groups.

These define standards for the personnel and technical equipment that are to become mandatory for certain services. States should be able to use the service groups for their hospital planning. The aim is to improve the quality of inpatient patient care. The reform is to come into force at the beginning of 2025.

Change happens through the back door

The Professional Association of German Anaesthetists (BDA) has strongly criticised the planned linking of the number of doctors with the performance groups. Markus Stolaczyk, head of the Health Policy Department at the BDA, complained that the legislator was ignoring critical voices and wanted to introduce the regulation through an amendment to the MFG, i.e. “through the back door, so to speak”.

Anaesthesiology and intensive care medicine are complex fields in which doctors occupy important interdisciplinary and intersectoral interfaces with almost all fields. “A detailed temporal allocation to service groups is not feasible in practice and would lead to an additional burden on the anaesthesiology specialists,” said Stolaczyk.

He explained that service groups are not intended for staff deployment planning. There is currently no evidence that staff can be effectively allocated to the medical needs of patients using service groups. “Instead, the German Medical Association’s ÄPS-BÄK staff assessment tool could be used as a suitable method for determining staff requirements in the individual specialist areas,” suggests Stolaczyk.

The tool is based on the personnel requirement calculation tools originally developed by the BDA, which were developed to calculate the medical staffing levels for anesthesiology and intensive care workstations. “If we want to find out whether there is an oversupply or undersupply of personnel in the individual specialist areas, we should rely on the ÄPS-BÄK of the German Medical Association and not on doctors’ stays that require documentation,” explained Thomas Iber, who originally co-developed the BDA tool and is part of the BDA presidium as secretary.

Additional documentation requirements feared

Apart from that, there is already an enormous amount of time spent on administrative tasks, which not only affects the medical care of patients, but also leads to increasing workloads and stress. In view of the shortage of skilled workers, this does not help anyone. “We need doctors at the patient’s bedside, not behind a desk with additional documentation obligations,” Stolaczyk clarified.

Both the German Hospital Association (DKG) and the Hessen Hospital Association recently criticized the planned regulation. The service groups, which are to form the basis of hospital planning from 2027, are much more differentiated than specialist departments, and a doctor can work in several service groups, writes the Hessen Hospital Association.

“This regulation once again shows the exaggerated theoretical approach of the Federal Ministry of Health, where there is obviously no knowledge of the practical work and organization in hospitals,” said Achim Neyer, CEO of the Hessen Hospital Association. An exact temporal allocation of medical activities to service groups is an incredible bureaucratic effort and practically impossible.

The managing director of the Hessen hospital association, Reinhard Schaffert, also criticized the procedure. “I believe that the introduction of controversial regulations in the parliamentary procedure via amendments with an extremely short deadline for comments is a deliberate method of the Federal Ministry of Health to keep the discussion to a minimum,” said Schaffert.

Of course, the parliamentary procedure is there to discuss the wording and to change it in the interests of improvement. “However, the fact that relevant regulations are deliberately not included in the actual draft law, but are only introduced later as an amendment, as can be seen between the lines of some statements by employees of the Federal Ministry of Health, is, in my opinion, a questionable understanding of democracy,” says Schaffert.

This approach, as well as the increasing tendency to define draft laws as urgent and to get them through the Bundestag as quickly as possible, ultimately leads to poorly crafted laws, he further criticized.

The Medical Research Act is to be passed in the Bundestag next week, explained Federal Health Minister Karl Lauterbach (SPD) yesterday at the Capital Congress (HSK). The aim of the reform is to improve the framework conditions for the development, approval and manufacture of drugs and medical products in Germany by accelerating and reducing bureaucracy in the approval procedures for clinical trials and licensing procedures. © cmk/aerzteblatt.de