Hospital.Help

Berlin Josef Hecken, the impartial chairman of the Federal Joint Committee (G-BA), warns of a deterioration in the quality of inpatient care due to the hospital reform. He is concerned that the reform could override the G-BA’s quality standards by means of legal regulations.

The result: We will have to deal with a reduction in quality on a broad scale, said Hecken today at a legal symposium of the G-BA. The G-BA still has the instrument of minimum quantities, the only instrument for quality assurance for care. But the states could soon make deviations here with the planned exceptions for the performance groups, warned Hecken.

The planned legal regulations, which require approval, would allow the states to have a say in defining quality in hospital care in the future. However, hospital planning sovereignty has its limits where quality is not met, said Hecken. According to him, the planned 65 service groups only contain rudimentary quality specifications for care.

Hecken further criticized the fact that public reports on the hospital reform say that it will increase quality and advance evidence-based medicine. However, the Hospital Care Improvement Act (KHVVG) is more of a quality reduction law and a state strengthening law.

Dagmar Felix spoke of the disempowerment of the G-BA, which is being carried out with the KHVVG. It can be seen that the G-BA is increasingly being deprived of its powers, said the professor of public law at the University of Hamburg, who is also a member of the Government Commission for Hospitals. The mood between politicians and the G-BA is currently worse than ever.

Until now, the G-BA has been responsible for setting quality criteria for German hospitals. One would have expected that the G-BA would also be the main player in this area as part of the hospital reform, said Felix. But that is not the case. In future, the minimum requirements for structural quality in hospitals will be set by the Federal Ministry of Health (BMG) in a legal ordinance.

The BMG is to be advised by a committee made up of representatives from the GKV umbrella organization, the German Hospital Association, the German Medical Association, university medicine and the nursing professions. The parallels to the G-BA are more than clear, said Felix. This will limit the G-BA’s authority to issue guidelines.

The G-BA may continue to implement quality assurance measures, but must ensure that there is no contradiction with the BMG’s requirements. This leads to unnecessary duplicate structures, criticized Felix.

The hospital reform will lead to an increasing nationalization of quality assurance in the inpatient sector. It remains to be seen whether the BMG can achieve the same level as the G-BA, says Felix.

Criticism of the Clinical Atlas and the Healthy Heart Act

Hecken also criticized the Federal Hospital Atlas, which does not offer the transparency that Lauterbach had promised. Citizens still have the impression that this is helping them, said Hecken.

He also criticized the planned Healthy Heart Act, which Lauterbach wants to push forward. The fact that the federal government wants to intervene directly in care with a new youth examination and the increased prescription of statins for prevention is state medicine. This can be done, but Hecken thinks it is worth considering that this should now be done with the consent of the federal states. In his view, the main problem is that the law wants to introduce evidence-free medicine. This is a threat to patient care.

Hecken criticized Federal Health Minister Karl Lauterbach (SPD) for years of fighting to ensure that decisions in healthcare are not made by just one person who has read a study. Lauterbach is currently pushing the law forward despite opposition from the medical profession and self-administration.

Winfried Kluth, professor of public law at the Martin Luther University of Halle-Wittenberg, also mentioned the advantages of self-administration dealing with quality instruments. In this way, complex processes are established with a calm generation of knowledge. Self-administration has both the expertise and the participation of many players in the health care system, emphasized Kluth.

This is a different quality than ad hoc hearings by ministries, said Kluth. However, the former judge admitted that the often long duration of the G-BA’s decision-making processes must also be taken into account. Overall, however, the costs of poor standard setting are higher than the costs of good standard setting, said Kluth. © cmk/fos/aerzteblatt.de