Hospital.Help

Berlin The quality criteria planned in the Hospital Care Improvement Act (KHVVG) cannot be compared with the quality specifications of the Federal Joint Committee (G-BA).

Karin Maag, an impartial member of the G-BA, emphasized this today at the start of the 15th G-BA Quality Assurance Conference in Berlin. The Parliamentary State Secretary in the Federal Ministry of Health (BMG), Sabine Dittmar (SPD), had previously described the new quality criteria that are to be introduced with the KHVVG.

The new service groups will be based on nationwide quality criteria that must be met so that a hospital can be assigned the service groups by the state, explained Dittmar. Of course, the further development of medicine must be reflected in the performance groups.

Therefore, a multi-stage process is planned in a performance group committee in order to further differentiate the performance groups, says Dittmar. Before a decision is made on the performance groups, the G-BA should be given the opportunity to comment. In addition, the committee’s office should be set up at the G-BA.

Dittmar emphasized that the G-BA’s existing quality assurance measures remain important instruments for improving the quality of medical care. However, in order to avoid overlaps, the G-BA should remove its own quality requirements if the quality criteria of the performance groups are comparable to those of the G-BA. This should also avoid avoidable expenses, such as double testing, says Dittmar.

Maag from the G-BA criticized this regulation and emphasized that the quality specifications of the performance groups could not be compared with the quality specifications of the G-BA. The quality criteria of the performance groups and the associated minimum retention numbers are not instruments for quality assurance of service provision, as the G-BA developed them and established them in practice, said Maag.

The service groups are service bundles summarized according to hospital planning standards. In contrast to the G-BA’s structural guidelines, the quality criteria linked to the performance groups are neither precisely tailored to particularly risky interventions nor are they evidence-based. Therefore, the quality criteria of the service groups could not replace the G-BA’s measures to ensure quality in the provision of services.

What specifications apply in the end?

Nevertheless, the KHVVG stipulates that in the future the G-BA may only set minimum requirements for structural, process and result quality if these requirements supplement the new quality criteria according to the KHVVG in the necessary manner and do not contradict them.

The G-BA would even have to repeal individual provisions in its guidelines or the entire guideline if all the requirements of the guideline are standardized in the new quality criteria.

These interfaces, or rather the obviously intended interlocking of planning specifications in the KHVVG and quality specifications of the G-BA, are already highly problematic from a legal point of view and remain largely unclear in terms of content, emphasized Maag.

If, for example, within the framework of the KHVVG, specifications were made for the provision of specialist staff for the entire performance group and at the same time there were higher G-BA specifications for individual, particularly demanding services within this group: Would the G-BA specifications then have to be repealed?

Minimum quantities change the structures

Maag gave an example: If specifications for the provision of specialist staff are made for the general surgery service group and the QS requirements in the G-BA’s structural guidelines are for individual, particularly time-critical services, such as the treatment of femur fractures, with regard to the The qualifications of the employees in the clinic are the same, but the number of employees required is higher: Do we then have to do away with it?

Maag also emphasized that the G-BA’s quality specifications led to structural changes in the healthcare system, for example through the continuous expansion of the minimum quantity regulation.

The AOK Federal Association published its transparency map last week: According to this, the increase in the minimum quantities for the treatment of breast and lung cancer in 2025 will lead to a significant concentration of care on those hospital locations that, with a lot of routine in the respective procedures, also achieve better treatment results achieve, said Maag.

Documentation effort reduced

In addition, the G-BA is continuously working to reduce the documentation effort in the healthcare system, for example by revising the guidelines for data-supported cross-institutional quality assurance. She admitted that the documentation effort for these procedures has sometimes exceeded the goal in an effort to continue to improve and with the best intentions to increase patient protection.

Two years ago, the G-BA therefore set out to make data-driven quality assurance more efficient and effective and to optimize the potential within the scope of the legal possibilities. We are increasingly relying on social data as well as data from patient surveys and, in the future, data from cancer registries in order to reduce bureaucratic costs, especially for service providers.

As a first step, the Institute for Quality Assurance and Transparency in Health Care (IQTIG) developed suggestions for further development of three QS model procedures, which had already been discussed and decided upon by the G-BA.

Step by step, all eleven data-supported quality assurance procedures are being revised, streamlined and improved, said Maag. In the future, the G-BA will limit itself to fewer, but more meaningful, indicators. With the path we have now taken, we primarily want to achieve a balanced cost-benefit ratio. © fos/aerzteblatt.de