Hospital.Help

Hamburg – The hospital reform is to be concluded in this “autumn of reforms” with the parliamentary procedure in the Bundestag and the Bundesrat. The federal states are hoping for significant changes to the current draft law and are threatening to set up a mediation committee if they do not. The federal government wants to avoid this with the experience gained from the transparency atlas procedure. However, the federal government has made little concessions to the states’ demands in a paper that has just been published.

In conversation with the German Medical Journal Hamburg’s Health Senator Melanie Schlotzhauer (SPD) explains what opportunities the reform must offer for a city-state, how she feels about a mediation process between the federal and state governments, and how Hamburg is preparing for the hospital reform.

5 questions for Hamburg’s Health Senator Melanie Schlotzhauer (SPD)

What is important to you as a representative of a city state at the hospital­reform important?
Hamburg is the healthcare metropolis in the north. Our city’s hospitals care for up to 30 percent of patients from neighboring states – in some specialist areas this number is even higher. This is particularly due to the existing specializations and the high level of expertise of our hospitals.

Hospitals want to and should continue to play this role in the future. However, specialist clinics such as the Protestant hospital in Alsterdorf, which specializes in inclusive care, or children’s clinics that are in demand nationwide have not yet been adequately represented in the financing system of diagnosis-related flat-rate fees in combination with the planned reserve financing.

The Federal Minister of Health has already made public concessions on my initiative. This is a great success.

For Hamburg, it is still of key importance whether cooperation between individual hospitals is possible and whether the states are given sufficient scope for this. The Jerusalem Hospital in Hamburg, for example, carries out the most breast cancer operations nationwide. It is a highly specialized hospital.

According to the federal government’s current ideas, we would have to add specialist departments to this hospital if we want to keep it. But that cannot be the solution. The clinic has long-standing and well-established cooperation relationships – both with the UKE and with the Agaplesion Diakonieklinikum. Such cooperation models must be reflected in the KHVVG.

Another point is the question of how many doctors can be included in the service groups. An example of this: For the area of ​​emergency medicine, it is currently planned that at least three specialists with additional training in “acute and emergency medicine” must be employed at a clinic.

The information I have says that this does not stand up to practical testing, because this additional qualification is simply not available with such frequency. So we would need longer transition periods or an adjustment of the requirements.

The precise design of the reserve financing is also an issue. In Hamburg, we also supply the surrounding regions. That is why we have high capacity utilization rates and we are currently assuming that the number of cases will continue to grow, as we are seeing a reduction in capacity in the surrounding area. The planned financing with the case number corridor, in which a maximum increase in the number of cases of 20 percent is possible, would slow this down and reduce treatment capacity. This should be adjusted.

I also advocate setting the proportion of reserve funding at more than 60 percent in order to make the hospitals even more independent of the number of cases. However, my impression is that the federal government is already too set in its ways of structuring reserve funding.

In your opinion, which demands of the countries must be taken into account in order to prevent a mediation committee?
I have not yet made this decision for Hamburg. Numerous discussions are currently taking place at all levels: with the Federal Ministry of Health, with the federal states and with the parliamentary groups in the German Bundestag. It is too early to draw red lines here. I am currently seeing movement at the federal level, which is very good. The next few weeks will show everything else.

Two weeks ago, during a visit to the Evangelical Hospital in Alsterdorf in Hamburg, the Federal Minister of Health announced a cost-coverage principle for certain clinics. Which clinics should be included in this, in your opinion?
I think the proposal is a good one and I have been a strong advocate for it. The two types of clinic (Note­Editorial staff: Children’s hospitals and clinics for the care of people with disabilities), which are now being discussed, cannot maintain their minimum case numbers in certain areas.

We have two children’s hospitals in Hamburg that do not belong to other hospitals. In summer, capacity is too low, but in winter the hospitals are full. This is why the provision of supplies is extremely variable and not economically viable. We must adopt a permanent cost-coverage principle for such hospitals. The Federal Ministry of Health must present financing models for this.

A recent initiative from your state – the joint investment cost financing of Schles­wig-Holstein and Hamburg for Hamburg’s clinics – was quickly rejected by her state colleague Kerstin von der Decken. Would Hamburg then contribute to investment costs for clinics in Schleswig-Holstein or Lower­Should Saxony participate and isn’t coordinated hospital planning between federal states even important in the future, because the population does not respect state borders when choosing a hospital?
The issue affects the entire medical landscape. On the one hand, it is good when patients come to Hamburg. This creates added value for the city and our hospitals and is good for the healthcare location. On the other hand, it means that the federal states surrounding Hamburg do not have to worry about certain things. Namely, how to ensure care in the surrounding area.

Together with our neighboring federal states, we have now commissioned reports that are intended to show exactly how many patients come to us, but also how many are treated in Schleswig-Holstein or Lower Saxony.

This data comparison of patient flows will not immediately result in more investment costs for hospitals in Hamburg, but it will provide clarity about where patients come from and how they receive care. In a next step, we can then address what this means for joint financing issues.

How are you already preparing for hospital reform in Hamburg?
The Senate has presented the citizens’ assembly with an amendment to the Hamburg Hospital Act that allows planning with service groups in Hamburg. The citizens’ assembly’s deliberations are not yet complete.

We are currently unable to plan with performance groups because they are not yet represented in the law. There will be a committee meeting on this in September. The corresponding amendment to the law is then to be decided this year, so that when the KHVVG comes into force, we will also have the legal basis in Hamburg to plan with performance groups.

This is the first step so that we can have a new hospital plan by January 1, 2026. In the next legislative period, further adjustments to the Hospital Act will be necessary because we have to deal with other issues such as digitization and data collection. © bee/cmk/aerzteblatt.de