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Berlin – The members of the Federal Joint Committee (G-BA) have raised the care of premature and full-term babies to a new quality standard and are requiring hospitals to more strictly adhere to the minimum number of nursing staff from 2027.

The quality assurance guideline, which has now been further developed in terms of content, primarily refers to the current guideline “Recommendations for the structural requirements of perinatal care in Germany” of the Association of Scientific Medical Societies (AWMF).

In addition, findings from the “clarifying dialogue” process conducted with hospitals that cannot meet the minimum requirements of the guidelines were also incorporated, the G-BA announced following the meeting.

In yesterday’s plenary session, the members approved a draft resolution submitted by the three referees. According to the chairman of the referee, Josef Hecken, there had previously been no agreement in the Quality Assurance Subcommittee on the revised version of the directive, so that there were more than 300 points that were not agreed upon.

This apparently included not only content-related but also editorial debates about grammar and comma placement, explained Hecken at the beginning of the discussion. The possibility for the referees to draw up their own draft resolutions in such cases and put them to a vote has existed since 2019.

The proposed directive will introduce sanctions from 2027 if the minimum requirements are not met, for example for nursing staff. The directive would make staffing requirements more flexible and at the same time more specific, the G-BA emphasizes.

The technical specifications of the current guideline with the highest level of recommendation are adopted by the directive as minimum requirements for the respective level of perinatal care, the G-BA announced.

If hospitals violate this requirement from 2017 onwards due to a lack of staff, the remuneration will be deducted proportionately. Invoicing will be done “on a daily basis”, as the impartial Karin Maag explained. The situation is different with the “further quality requirements”: Failure to meet the further quality requirements will be recorded, but will not lead to a loss of remuneration, the G-BA emphasises.

Discussion about sanctions

The discussion in the G-BA plenary session was particularly focused on the issue of sanctions and the deployment of nursing staff: The chairman of the German Hospital Association (DKG), Gerald Gaß, explained that as a consequence of the directive, more hospital directors of level-1 perinatal centers would retire from care.

The threatened sanctions of receiving the full DRG payment for the day without sufficient nursing staff as well as the complete loss of the corresponding nursing allowance are no longer acceptable for many managers.

In his view, after locations are closed, nursing staff would not move to other locations that would then have to care for more patients. This would create waiting lists that should not arise in the case of premature baby care, says Gaß.

He also explained that the AWMF guideline, which now forms the basis for the G-BA guideline, had been interpreted far too broadly. The quality requirements of the G-BA resolution went far beyond the requirements that the scientific professional associations consider necessary. He therefore called for the resolution to be reconsidered and re-examined.

Neither the representatives of the health insurance companies nor the patient representatives could follow this argument. Doris Pfeiffer, Chairwoman of the GKV-Spitzenverband, explained that the guidelines set the minimum requirements and that these would be further developed in the G-BA for care. She argued for the sanctions, which the hospitals would not face until 2027, to be set earlier.

This is also what the patient representatives demanded: “Quality assurance is always controversial. Because something is supposed to be made transparent that interested parties do not want to have so clearly visible,” said the spokesperson for quality assurance of the patient representatives in the G-BA, Wolf-Dietrich Trenner.

In the plenary session, he also clearly stated: “If parents knew how much depends on the good care of premature babies, they would accept completely different ways to get good care.” He clearly demanded that there must be consequences for hospitals that do not comply with staffing requirements.

“The nursing staff must be trained. I would like the states to have to prove what they are doing to train staff.” He also called for the sanctions for hospitals to take effect much sooner, without the planned transition period. In the vote on this, the health insurance companies voted in favor, the impartial representatives and the DKG voted against.

When voting on the directive as a whole, the impartial members voted with the health insurance companies and against the DKG. Following the decision, the DKG once again clearly criticized the vote in a statement.

“The revision of the quality assurance guidelines for premature and full-term babies will endanger the current good care of premature babies in Germany in the medium term compared to other countries,” said Gaß. The quality requirements are “in the spirit of the statutory health insurance” and are being taken to extremes with “very high financial sanctions.” He sees the “AWMF medical guidelines as being misused and abused as a sanctioning instrument.”

The federal states, which were not personally present at the meeting, also share the DKG’s argument and demanded that the directive not be voted on in this form. The impartial Hecken quoted from the email in which the states explained their decision: They too fear that the number of perinatal centers will decrease and that the centers that remain will become larger and larger. The nursing staff limits cannot be met and the existing staff will not change location. © bee/aerzteblatt.de