Hospital.Help

Berlin – A mediation procedure in the course of hospital reform is to be prevented. This was announced today by Federal Health Minister Karl Lauterbach (SPD) at the hospital summit of the German Hospital Association (DKG).

Politicians from outside the field are often involved in the mediation process, which is why the results of such processes are often more outside the field than if an agreement had been reached beforehand, said Lauterbach. The minister announced today that the wishes of the federal states should therefore be taken into account in the parliamentary process.

He is referring to the dispute over hospital reform that has been going on for months. Some federal states have therefore already threatened to call on the mediation committee in order to push through their demands in the legislative process. Minister Lauterbach has so far paid little attention to these demands.

For specialist clinics, for example, there will be different rules than those currently provided for in the draft of the Hospital Care Improvement Act (KHVVG). This means that in future they will not have to provide general service groups and the corresponding personnel and technical equipment, explained Lauterbach.

In addition, hospitals that care for children with disabilities are to be exempted from the planned flat-rate provision fees. He had already suggested the possibility of a cost-coverage principle for some clinics last week.

Lauterbach stressed today that these “smart and sensible” wishes of the states will be taken into account and incorporated into the KHVVG for the planned second and third reading in the Bundestag.

The possible date for the appeal to the mediation committee would be November 22nd, explained the chairman of the board of the DKG, Gerald Gaß. On this day, the Federal Council will meet after the possible announced second/third reading of the KHVVG on October 18th.

However, the law must not be held up in the Bundesrat, said Gaß. “It must not come to that.” Criticism also came today from Brandenburg’s Health Minister Ursula Nonnemacher (Greens). She criticized the tight schedule and called it “completely unrealistic.”

Further problems in implementation

Lauterbach also admitted that the reform could change in other areas. There are difficulties in implementing “two or three service groups,” Lauterbach said today. There are problems with the planned service groups for special geriatrics and special pediatric surgery, for example.

If it is seen that these performance groups do not work, then they will be abandoned and instead the performance group concept from North Rhine-Westphalia will be adopted, said Lauterbach. The NRW concept provides for 60 somatic performance groups without the two mentioned.

Lauterbach explained that work is also continuing on the impact assessment of hospital reform. This instrument should be available at the end of September. He is referring to an analysis tool that members of the government commission for hospitals and representatives of the GKV umbrella association are working on. The head of the government commission, Tom Bschor, presented the first results of the simulation model to the German Medical Journal explained in April.

Gaß suggested further changes to the hospital reform. He appealed to the members of the Bundestag to amend the KHVVG accordingly. Above all, the planned reserve financing is a thorn in Gaß’s side.

“There is no reserve financing that is independent of the number of cases,” said Gaß, alluding to the regulation in the KHVVG that states must either allocate planned case numbers for service groups to hospitals or the previous year’s case numbers apply in order to calculate and pay out the reserve financing.

Allocation of planned case numbers difficult

The parliamentary state secretary in the BMG, Edgar Franke (SPD), pointed out this very allocation of the planned case numbers in this debate. According to Gaß, this is “nicely written down” but will never be implemented in reality. Because that would mean that if the planned case numbers for some hospitals were increased, the numbers in other clinics would have to be reduced.

Franke also surprisingly admitted today: “There will be no de-economization.” The previous year’s case numbers will be a benchmark for the planned reserve remuneration, said Franke. Because it is not possible to completely de-economize.

Economics is not unethical in the area of ​​health either, he said, instead the hospital reform should reduce the economic pressure on hospitals. In doing so, he expressed himself differently than Lauterbach, who in recent months has repeatedly promised a de-economization of the inpatient sector through the planned hospital reform.

Flat-rate surcharges for independent financing

More independent financing could be an increase in the surcharges for hospitals for emergency care, suggests Gaß. Hospitals could also receive lump sum support for training and further education in the future in order to be able to finance this area better in the future, he continued. There are many areas that can be supported without taking case numbers into account, says Gaß.

If this is not done, there is a risk of waiting list medicine, said Gaß. Lauterbach countered this fear. “I am confident that we are far from that,” he said. Although there are considerable delays in getting appointments, this does not affect the hospital sector, said Lauterbach.

“The planned reserve financing is not reserve financing, but a type of deferred flat-rate fee,” criticized Ates Gürpinar, member of the Bundestag from the Left Party group. He explained that the hospital reform could not be saved with amendments, but was going in the wrong direction.

First, hospitals need to be supported financially and then reforms can be implemented, he suggested. “If you want the reform to take effect, you need something for the transition so that the reform can take effect.”

According to Tino Sorge, CDU member of the Bundestag and health policy spokesman for the Union parliamentary group, an impact analysis and a needs analysis of the hospital reform are still needed. In addition, states would have to be given more opening clauses to allow exceptions from the performance groups for certain clinics.

He also criticized the way the BMG deals with members of the Bundestag. Important information on planned legal regulations or possible impact analyses, such as the Grouper currently being developed, should not reach parliamentarians until the evening before important votes in the Bundestag. However, he criticized that this had been the practice for some time.

Armin Grau, member of the Bundestag and Green Party rapporteur for hospital policy, defended the reform following the summit. According to Grau, it will improve quality, counteract false economic incentives and improve financial planning security for hospitals.

Since the economic situation of many hospitals is strained, hospital reform cannot be postponed any further. “Without effective and timely hospital reform, many more hospitals would face existential economic hardship and the result would be an uncontrolled decline in hospitals.”

However, he also announced that the law would be tightened up where necessary in order to reliably and comprehensively increase the quality and efficiency of hospitals in the interests of patients and staff throughout our country.

“We will also take into account the assessments of experts and associations from practice in a public hearing in the Health Committee.” This hearing is scheduled for September 25. © cmk/aerzteblatt.de