Hospital reform: States threaten mediation committee

Hospital reform: States threaten mediation committee


Kerstin von der Decken (CDU), Minister for Justice and Health in Schleswig-Holstein /picture alliance, Frank Molter

Berlin – If the main demands of the states for hospital reform are not taken into account in the parliamentary process, the Federal Council will call on the mediation committee. This was announced today by Schleswig-Holstein Health Minister Kerstin von der Decken (CDU) after a federal-state round.

She is now hoping for the parliamentary process. “It is still too early to bury our heads in the sand,” said the chairwoman of the Conference of Health Ministers (GMK) today.

The states submitted their statement with requests for changes to the draft Hospital Care Improvement Act (KHVVG) on time and in unison at the end of April. “And to our great disappointment, not a single one of these requests for changes has been included in the draft law,” complained von der Decken.

The hospital reform provides for the introduction of 65 service groups. These are intended to improve the quality of care through nationwide criteria for material and personnel resources. The hospitals must meet the criteria in order to be able to provide and bill for services in a certain service group.

In addition, there will be reserve funding that will replace 60 percent of the diagnosis-related flat rates (DRG). The funding and service groups will be interdependent. The third change is planned to be cross-sectoral care facilities (formerly Level 1i clinics), which will act as small hospitals that form an interface between outpatient and inpatient care.

Federal Health Minister Karl Lauterbach (SPD) explained to the states today which of their demands were acceptable and which would be rejected, explained von der Decken. “What we heard today is relatively disappointing from the states’ point of view,” the minister continued. Among the rejected demands were the states’ main demands, such as more flexible options for planning service groups. This also included more opportunities for cooperation between clinics.

Ensuring basic and emergency care in rural areas

Von der Decken is concerned about basic and emergency care in rural areas. In some cases, there is already a shortage of specialist staff. Too high quality requirements within the service groups, which cannot be met, would not improve care, she said when asked by the German Medical JournalShe stressed that the states would not want to exploit exceptions for performance groups, but would use them for the benefit of the population.

In addition, Lauterbach rejected the adjustment of the planned changes to the reimbursement system requested by the states. The states are demanding that the financing reform takes greater account of smaller hospitals.

Lauterbach gave his approval for minor details, said von der Decken. Deadlines for medical service examinations should be extended, for example, which could help reduce bureaucracy. He also agreed to involve the states in the committee preparing the planned legal regulations. These are to come into force next year according to the law and will further develop the planned performance groups.

Federal states stand together “16:0”

Von der Decken was optimistic that as many of the states’ demands as possible would be incorporated into the KHVVG via amendments in the parliamentary process. A first reading is to take place in the Bundestag before the summer break.

If the main demands of the states are not incorporated, the Bundesrat will have to go through a mediation process, she said. “This can happen quickly if agreement is reached. But it can also take longer.” On this issue, the states are “16:0” in agreement. This is remarkable. The minister hopes, however, that this will not be necessary. She reiterated that the states want and need hospital reform.

The topic of impact analysis of the reform was also on today’s agenda. Lauterbach assured that all the conditions needed to implement this would be in place in September. The minister had already announced that the grouper for linking the planned performance groups with the DRGs would be completed in September.

Von der Decken stressed that it would be irresponsible to implement such a major reform law without examining the impact on the hospital landscape. She hopes to gain quick insights. These should also have an impact on the text of the law, said von der Decken. Lauterbach himself did not comment today after the federal-state round.

SPD parliamentary group against exceptions to quality criteria

Opposition to the exemption criteria demanded by the states has already come from the Bundestag today. SPD Bundestag member Christos Pantazis stressed that uniform nationwide quality criteria are needed in medical care “despite a benevolent review of possible exceptions to minimum structural requirements.” The quality criteria remain an elementary component of the reform, as they are of central importance for the safety of patients’ health.

“In particular, the revolutionary core of this far-reaching hospital reform in the form of sector-linking care facilities offers the opportunity to ensure high-quality care in rural states,” said Pantazis. The federal and state governments must recognize this necessity in order to work together constructively and push the reform forward.

The chairwoman of the AOK Federal Association, Carola Reimann, called for constructive cooperation between the federal and state governments. There is no need for reform at any price with high additional expenditure that would be spread across a hospital structure that is no longer up to date.

“Instead, the right course must now be set for the further development of German hospitals. They should also be implemented more quickly and consistently than previously provided for in the KHVVG. To this end, the necessary details in the regulations provided for this purpose should also be made promptly,” said Reimann.

Planning security required

She spoke out in favor of planning security and solid financing through flat-rate provision for the clinics. These should be paid regardless of the number of cases treated and should be based on the needs of the population, said Reimann. She also emphasized: “The quality of treatment must not be sacrificed in the negotiations between the federal and state governments by making questionable compromises.”

Jens Baas, CEO of Techniker Krankenkasse (TK), also complained: “The debate is currently only about maintaining hospitals regardless of the actual need for care and minimizing the financial burden on the states.” The necessary structural changes for more specialization and the associated improvement in quality for patients have been lost sight of in the political wrangling over competence.

“To improve the quality of hospital care, we urgently need a better division of labor between hospitals and greater specialization in complex procedures,” said Baas. The originally envisaged quality goals have been pushed into the background in the discussion. The focus of the reform should be on providing people with the best possible care. The federal government should not buy the states’ approval by making compromises on the uniform quality standards.

Bernadette Rümmelin, managing director of the Catholic Hospital Association, is now also hoping that the government parties will help. They should get Lauterbach to give in. The minister’s political “haggling” is keeping the hospitals in complete uncertainty about what the future will bring. “The government parties in the Bundestag must not simply wave through the law in the form decided by the cabinet,” demands Rümmelin.

The hospitals finally need planning security and a perspective. “In addition to effective inflation compensation, this includes the prospect of a financing reform that refinances the actual holding costs for the locations that need them. A ‘light flat-rate system’, as envisaged in the draft law, will certainly not relieve the hospitals of economic pressure,” said Rümmelin. © cmk/

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