Hospital.Help

Berlin – Federal Health Minister Karl Lauterbach (SPD) is offering the states a fixed day to discuss hospital reform. He announced this today before the Bundesrat.

All state prime ministers and health ministers can contact him directly at this meeting every two weeks without registering, Lauterbach explained. He does not want there to be any further misunderstandings in the discussion about hospital reform. With this proposal, Lauterbach is apparently trying to accommodate the states.

They had made it clear again today before the Chamber of States that, in their view, the current draft of the Hospital Care Improvement Act (KHVVG) would not achieve the agreed goals of the reform. They threatened again to call on the mediation committee. This approach would significantly delay the timetable for the reform.

The hospital reform provides for the introduction of 65 service groups that are intended to establish uniform quality and equipment criteria across the country. The federal states should be able to assign service groups to hospitals as part of their hospital planning.

The plan is to exclude occasional care and improve the quality of patient care. In addition, provisional funding of 60 percent of the total operating costs is to be linked to the service groups. The remainder is to continue to be financed through diagnosis-related flat rates (DRG).

Furthermore, cross-sectoral care facilities are planned to ensure basic care, especially in rural regions. The KHVVG is currently being discussed in the Bundestag. A public hearing on the matter is expected to take place in the Health Committee on September 25th. The reform is scheduled to come into force on January 1st, 2025.

The current version of the KHVVG should be rejected, said Brandenburg’s Health Minister Ursula Nonnemacher (Greens). Uniform federal guidelines are not suitable for taking regional peculiarities into account, she criticized with regard to the planned benefit groups. Nonnemacher called for practical opportunities for cooperation and binding and permanent exemptions from the benefit groups in sparsely populated areas.

Completely excessive staffing requirements

The draft of the KHVVG shows “serious weaknesses,” emphasized the Bavarian Minister of Health Judith Gerlach (CSU). From the state’s point of view, the reform process has been “sobering.” For her, it is important that the population be provided with care close to their homes. Therefore, there must be more possibilities for exceptions to the criteria for the benefit groups, she also demanded.

Gerlach criticised the current regulations in the KHVVG, saying they would threaten the structure of cooperation and alliances that had been built up over the past few years. She also criticised the “completely excessive personnel requirements” for some service groups, particularly in the area of ​​pediatrics. Structural requirements are provided here that some clinics simply cannot meet due to the lack of skilled workers. Gerlach fears that this will result in clinic locations being lost.

Lauterbach replied to Nonnemacher that no other federal state, measured by population size, would benefit as much from the planned ten new surcharges for pediatrics, emergency care or obstetrics as Brandenburg.

Hospitals that receive security bonuses will no longer have to meet the quality criteria of the service groups and will still receive the planned reserve budgets, explained Lauterbach. This will happen permanently, “because we absolutely have to keep the hospitals,” he stressed. When this regulation was implemented, scientists cried because of the departure from quality, said Lauterbach.

If this regulation is still not sufficient to financially support clinics in rural areas, they could be converted into Level 1i clinics (cross-sectoral care facilities), Lauterbach suggested. These should be paid according to the cost-coverage principle and would therefore negotiate with health insurance companies what their costs are per day. These would then be reimbursed as a daily flat rate, said Lauterbach.

In response to criticism of the excessive personnel requirements in the service groups, Lauterbach replied that the three specialists required in most service groups could be counted for three different service groups. “That is the absolute minimum. If we do not do that, we could save ourselves the specialist standard,” Lauterbach stressed.

Municipalities support hospitals with millions

Lower Saxony’s Prime Minister Stephan Weil (SPD) mentioned the current unbearable situation of hospitals. In Lower Saxony, municipalities have had to support their hospitals with more than half a billion euros in the past two years. This shows the need for reform.

However, for a timely reform, the serious and reliable advice from the states must be taken into account, stressed Weil. He renewed the states’ call for an impact analysis of the reform. “You cannot ask the states to buy a pig in a poke,” said Weil. The Federal Ministry of Health (BMG) must be prepared to share its knowledge with the states.

Such an impact analysis will only be possible once the grouper, which links the service group system with the diagnosis-related flat-rate payment system (DRG), is ready, explained Lauterbach. This will be the case in September and this is why such an analysis has always been announced for September.

However, such an analysis also requires that the states allocate the performance groups to the locations. In North Rhine-Westphalia, for example, an analysis could be carried out because the state allocated 60 of the 65 planned performance groups to hospitals a few weeks ago after a reform process lasting several years. Lauterbach called on the states to carry out corresponding checks.

Weil also criticized the planned regulation regarding the transformation fund, which states could only take fresh money for the restructuring of hospitals as part of the reform. This would punish the states that have already started to adapt structures now or in recent months, Weil complained. “That cannot be what is intended.”

Lauterbach agreed with Weil on this point and explained that appropriate regulations should be found that take into account if countries have permanently increased their investment costs. “We must not punish the countries that have now increased their commitments,” Lauterbach explained.

Weil and the Bavarian Minister of Health Gerlach, among others, also clearly criticized the fact that specialist clinics would have to maintain service groups in internal medicine, surgery and intensive care medicine in the future.

Lauterbach explained that corresponding exceptions for specialist clinics had already been promised. This change is not yet included in the KHVVG, as it would only be possible with the consent of the parliamentary groups. However, they also consider this exception to be necessary. It can therefore be assumed that a corresponding amendment will be submitted to the Bundestag.

Reduction of bureaucracy rather than increase is required

For the Health Minister of Schleswig-Holstein and Chair of the Health Ministers’ Conference (GMK), Kerstin von der Decken (CDU), bridging financing is needed for hospitals until the reform takes effect. Bureaucracy needs to be reduced rather than increased. “One third of the draft consists of inspection and reporting obligations,” she criticized. She also insisted on a provisional fee that is independent of the number of cases.

If the changes demanded by the states are not made, then the mediation committee will meet, warned the Health Minister Manne Lucha (Greens) from Baden-Württemberg. The Health Minister from Thuringia, Heike Werner (The Left), also said: “There does not have to be a mediation committee, but if the interests of the states are not taken into account, then we will have to talk about it.” GMK Chairwoman von der Decken had already announced something similar a few weeks ago.

In addition, the states today agreed on a number of concrete proposals for improving the KHVVG. For example, the Federal Council rejects the idea of ​​financing the transformation fund from contributions from those with statutory insurance. Instead, the federal subsidy to the Health Committee should be increased by the corresponding amount in order to prevent those with statutory insurance from being disadvantaged, according to a recommendation.

With regard to the transformation fund, the catalogue of eligible measures is also too narrow. However, the states are demanding that all projects for the concentration of acute inpatient care capacities across locations be included in the catalogue.

“This concerns the overall complex of preparing for future challenges and impending crises, such as extreme weather, heat or the shrinking personnel capacity, but also possible pandemics; it concerns the ecological transformation towards lower resource consumption and reduced emissions; but it also concerns the future viability (and long-term modernization) of the infrastructure,” the states write. If these eligible aspects are missing, the Transformation Fund will hardly be able to develop its full effect.

Another proposal states that health insurance companies and substitute funds should not be involved in the allocation of service groups that deviate from quality criteria to ensure comprehensive care. This decision should only be made by the relevant state authorities. “Otherwise, self-administration would have an inappropriate influence on hospital planning,” the justification states.

With regard to cross-sectoral care facilities (Level 1i clinics), the states are also demanding that these cannot only be converted from existing hospitals, as Lauterbach had also described.

They should also be made possible as newly constructed buildings or as buildings that were not previously intended for patient care. “If there is a need for a cross-sector care facility, it should not matter whether or not a convertible hospital already exists in the relevant region (by chance).” © cmk/aerzteblatt.de