Hospital.Help

Berlin – The current chairwoman of the Conference of Health Ministers (GMK), Kerstin von der Decken, has called for comprehensive changes to the Hospital Care Improvement Act (KHVVG) in order not to destroy established care structures in the federal states.

The cabinet draft of the KHVVG contains rigid guidelines for the whole of Germany that would destroy good healthcare services in the states, said the Minister of Health of the State of Schleswig-Holstein today to journalists in Berlin on the occasion of tomorrow’s first reading of the KHVVG in the Bundestag.

She criticized the fact that the Federal Ministry of Health (BMG) had not included any of the changes that all 16 federal states had jointly formulated in the cabinet draft. “That is very unusual,” said von der Decken.

There is no disagreement between the federal and state governments that hospital reform is necessary. “We also all agree on the goals,” said the minister. “We need a centralization of planned interventions in individual locations, while at the same time ensuring that basic and emergency care functions across the country.”

However, it is essential to conduct an impact analysis before the reform is passed in order to understand how the KHVVG will change the hospital landscape in Germany.

Regulations for specialist clinics

In addition, practical regulations are needed for the planned cross-sectoral care facilities, in which both inpatient and outpatient services are to be provided, as well as for specialist clinics.

According to von der Decken, specialist clinics are barely mentioned in the KHVVG. According to the current draft of the KHVVG, they would also have to have a department for internal medicine, a department for surgery and an intensive care unit. “That is not feasible,” stressed von der Decken. “As a result, specialist clinics would have to close.”

In addition, transitional financing is needed to compensate for the increased costs for hospitals, particularly as a result of inflation, so that no hospitals that are in need have to close before the reform takes effect.

Maintain cooperation

In particular, von der Decken criticized the fact that cooperation between hospitals was made impossible by the provisions of the KHVVG, since services had to be provided at a single location.

The managing director of the West Coast Clinics Brunsbüttel and Heide, Martin Blümke, gave examples. “Once a week, specialists from the University Hospital Schleswig-Holstein come to our Heide location to provide cardiac surgery services,” he said. “This is a great benefit for our patients.” With the KHVVG in its current form, this would no longer be possible because services can only be provided at one location.

“We support a hospital in North Friesland in the area of ​​pediatric care, as it has a large and important obstetrics department but no children’s clinic of its own,” continued Blümke. “Our colleagues from Heide come to North Friesland and provide the necessary services there so that mother and child do not have to be brought to us.” This cooperation would also be at risk because billing for these services would not be possible at the North Friesland location.

Effects on structures cannot be predicted

Blümke criticized the fact that the effects of the hospital reform on the structures are currently difficult to predict. “The actual idea was a reform of hospital remuneration,” said Blümke. However, the corresponding regulations contained in the KHVVG are formulated in such a way that no one can understand them anymore.

“Nobody can currently say what the remuneration will ultimately look like,” criticized Blümke. “Nobody can predict the effects that the regulations will have on the structures. No hospital manager can therefore plan how he will be remunerated in the future. That is a real problem.”

And as long as the federal guidelines are not set, the hospitals cannot make their own structural changes. The main problem is that the specialists cannot be moved from one location to another like on a chessboard. “We are worried that we could lose the active and high-quality cooperation that has been going on in Schleswig-Holstein for many years,” says Blümke.

Concern for cross-sectoral facilities

He also criticized the fact that the funding for cross-sectoral care facilities provided for in the KHVVG is not sufficient to finance the corresponding facilities. “In recent years, we have expanded our location in Brunsbüttel with around 100 beds into a cross-sectoral facility,” explained Blümke.

“At this location, in addition to inpatient care with emergency care, we have a medical care center, resident doctors and health professionals such as occupational therapists. I am concerned that such a facility will no longer be able to be financed with the KHVVG in the future.”

Blümke called for uniform financing for cross-sectoral care facilities, which would also make it possible to provide an emergency room: “It would be nice if we could say goodbye to fragmented financing and get an overall budget system here.”

“There is still enough time”

Von der Decken concluded by expressing optimism that the demands of the federal states would be included in the law during the parliamentary process. “We are now at the very beginning of the process,” she said. “There is still enough time and opportunity to include our demands.”

If nothing changes in the draft law during the parliamentary process, the states would call on the mediation committee. “But that is only the second step,” said von der Decken. “It is easier, faster and more effective to achieve the necessary changes in the Bundestag.” © fos/aerzteblatt.de