Hospital.Help

Berlin – The Health Committee in the Federal Council will vote tomorrow on a proposal for hospital reform. The application from the states of North Rhine-Westphalia, Baden-Württemberg, Bavaria, Saxony, Saxony-Anhalt, Schleswig-Holstein and Thuringia recommends contacting the mediation committee. The application is that German medical journal before.

The mediation committee – with representatives from the Bundestag and Bundesrat – is intended to provide a framework for renegotiations of the controversial Hospital Care Improvement Act (KHVVG).

The Bundestag passed the law on October 17th. It can probably be stopped or blocked for the time being in the Federal Council on November 22nd if a majority of the states call the mediation committee. This requires at least 35 of the 69 state votes in the Federal Council. The applicant countries together achieve 34 votes.

In another current paper from the states of Bavaria, Baden-Württemberg, Hesse, North Rhine-Westphalia and Schleswig-Holstein, central demands are emphasized again. This paper is also based on that German medical journal before.

It is interesting that this paper called “Central reasons for calling the Mediation Committee on the Hospital Care Improvement Act (KHVVG)” is also supported by Hesse. The state had not yet made a decision as to whether it would appeal to the mediation committee.

If Hesse were to decide to do so, there would be 39 votes in favor of appealing to the mediation committee, including the states that submit the application to the Federal Council’s Health Committee.

States fear becoming subordinate authorities to the federal government

The aim is not to prevent the federal hospital reform, but rather to improve the Hospital Care Improvement Act (KHVVG), the five states write in the paper. And: “The states must not be demoted to a subordinate authority of the federal government and only implement requirements that are defined at the federal level.”

Accordingly, they set out five central demands for change that would have to be anchored in the law. The five countries are insisting on relaxing the specified quality standards, for example that specialists cannot only be counted in a maximum of three performance groups. In addition, there should be further possible exceptions to the criteria in the performance groups.

If comprehensive inpatient care cannot be ensured otherwise, the states must be able to make exceptions to quality requirements “with a sense of proportion,” it is said. The states should also be able to declare exceptions in disaster scenarios, such as floods. And: The states demand that quality criteria should also be provided to a much greater extent in cooperation and alliances.

Different location definition and bridging financing required

The states also criticize the location definition underlying the reform, which states that hospital locations should not be more than 2,000 meters apart. Municipal hospitals in large cities consist of several buildings, some of which are more than 2,000 meters apart for urban planning reasons, the states write.

In addition, the federal states once again called for reserve financing that is independent of the number of cases and bridging financing to help economically struggling clinics until the reform takes effect. In addition, the planned assessment of the insolvency risk when applying for transformation fund projects should be deleted, the states demand. This additional application requirement involves considerable effort for the states.

The five countries are also demanding further changes with regard to specialist clinics. It doesn’t make sense for specialist clinics to be allowed to provide 80 percent of cases in a maximum of four service groups. Initial impact analyzes using the simulation model of the Federal Ministry of Health (BMG) show that this division is not practical.

“After an initial evaluation within the scope of the technical possibilities in several countries, it was noticed that recognized specialist clinics, some of which are sponsored by the country, with a high level of medical expertise in patient care do not fall under the definition.” This is associated with disadvantages when it comes to meeting other quality criteria .

And: The planned further influence of the Federal Joint Committee (G-BA) in the KHVVG does not make the five states happy. For example, the quality specifications for the midwife-led delivery room are to be prepared by a federal-state committee. According to the states, it does not fit into the system that the G-BA should also set binding specifications for criteria and quality requirements for the midwife-led delivery room. These demands are also described in the proposal for tomorrow’s Health Committee in the Federal Council. © cmk/bee/aerzteblatt.de