Hospital.Help

Berlin – Transformation funds, medical training, provision allowances and the impact analysis of the planned hospital reform: the Health Committee of the Bundestag dealt with these key words from the proposed legislation on the Hospital Care Improvement Act (KHVVG) in today’s hearing.

The project has thus overcome another hurdle in parliamentary work. The complex law was discussed in the expert hearing for two hours. The acting chair of the committee, Kirsten Kappert-Gonther (Greens), called the meeting a “large and, for us, fundamental hearing, with many experts and many perspectives.”

In response to questions from members of the three coalition factions, numerous experts called for changes to the provision remuneration provided for in the KHVVG, which is actually intended to free hospitals from the hamster wheel of volume expansion, but which, according to the draft law, is linked to the number of cases provided.

“We criticize the fact that the provision funding is not designed to be independent of the number of cases,” said Gerald Gaß, Chairman of the Board of the German Hospital Association (DKG), among others. Specifically, the draft law provides that the amount of the provision fee should be based on the number of cases that the hospitals will have provided in 2025.

“This gives hospitals an incentive to increase their case numbers. We think that’s counterproductive,” said Gaß. “We are calling for reserve funding that is truly independent of case numbers and that is designed, for example, in a similar way to the surcharges that already exist in the system today, such as center surcharges or surcharges for emergency care.”

Pay part of the reserve budget into a fund

Jonas Schreyögg from the University of Hamburg also suggested moving the reference years into the past. “If the reference years are in the future, hospitals will try to increase their case volume in order to get the highest possible flat rate,” said Schreyögg in response to a question from the FDP parliamentary group.

“We are therefore in danger of seeing a renewed increase in the volume of inpatient services, which would bring hospitals’ efforts to outpatient care to a standstill. The years 2023 and 2024 would be more suitable as reference years – or 2023 alone.” Christian Karagiannidis, member of the Hospital Expert Commission, who was questioned on the subject by the Greens, also agreed with this suggestion.

Schreyögg also criticised the planned payment of the reserve budget to hospitals as being too bureaucratic. In addition, it offers incentives for a “liquidity-oriented increase in volume”.

Schreyögg suggested that the budget should not be paid out in full to the hospitals, but initially also into a reserve fund that could be located at the Federal Office for Social Security (BAS). One of the advantages of this would be that the BAS would have an overview of the payments.

The members of the coalition factions also focused particularly intensively on the elements of cross-sectoral care, which the KHVVG is also intended to emphasize. The “basic idea of ​​cross-sectoral care is good,” explained Ferdinand Gerlach from the University of Frankfurt. The health system suffers from the “thick walls of the sectors.”

His suggestion: There should be no “pseudo-solutions” in the cross-sectoral work in the new planned facilities that would encourage “cherry-picking” in individual specialist groups. The regulatory and performance law should also be adapted for local cooperation.

Gerlach suggested that hospital reform should introduce a primary care service group, which would also include home visits, nursing and long-term care. This new form of care would have to be time-limited, and the services billed would have to be compared with routine data, he said.

Gerlach is convinced that such a cross-sectoral center must be run in cooperation with existing local practices. In addition, such a center should initially only be set up in underserved regions and then evaluated.

The future of medical training in hospital reform was questioned by SPD and CDU MPs from the experts: The President of the German Medical Association, Klaus Reinhardt, made it clear that the planned Level 1i clinics could offer further training for doctors “to a certain extent”. However, this would be significantly limited by the range of services that would be provided in the hospitals in the future.

Susanne Johna, 1st Chairwoman of the Marburger Bund and Vice President of the German Medical Association, also pointed out that “further training has not yet been taken into account” in the reform process.

“With the planned 65 performance groups, many young doctors will have to change location and employer more often in order to maintain their qualifications. And this at a stage of life in which family planning also plays an important role,” emphasized Johna. She suggested that the state medical associations should be empowered to set up appropriate certified training associations in order to ensure rotations between different clinics.

In response to a question from the SPD parliamentary group, Johna also advocated the inclusion of a medical staff assessment instrument in the KHVVG. “Having sufficient staff in the hospital is an important quality factor,” Johna emphasized. “That is why the German Medical Association set out in 2019 to develop a medical staff assessment instrument that can be used to calculate how many doctors need to work on each wards.” It is important to include such an instrument not only for nursing care, but also for medical services.

The opposition tried to use its questions to point out the weak points of the law: for example, a needs and impact analysis must be carried out before the law is passed. Hannes Dahnke, individual expert and founder of the data analysis system Vebeto, warned that simulations of the effects of the legislative plans already exist using routine public data.

The problems with specialist clinics that cannot reach the required minimum number of cases could have been seen much earlier. “Many other problems with the reform can be seen in the simulations using public data; you don’t have to wait for the grouper to do that,” says Dahnke.

The Grouper can be used to recalculate the performance groups in connection with the DRG system. This calculation tool was supposed to be available early in the year, but then the deadline was pushed back to the end of September. Now the tool may not be ready before the law is passed.

The Catholic Hospital Association proposed a much more extensive needs analysis tool: after a detailed needs analysis, there must be an impact analysis that also provides needs orientation over several years. This analysis must also include demographic and geographical aspects of the respective region in order to achieve good results.

After the experts have been heard, discussions will now continue within the government parties. The way in which questions were asked and on what topics already allows conclusions to be drawn about possible changes to the reform plan.

The law is to be discussed in the Bundestag in mid-October – the Bundesrat will then deal with it. Many ministers from the federal states are still keeping an open mind as to whether there will be approval here or whether a mediation committee will be called upon. © bee/fos/aerzteblatt.de