Gerald Gaß, Chairman of the Board of the German Hospital Association (DKG). /image alliance, Britta Pedersen
Berlin – The German Hospital Association (DKG) has compiled its most important demands for changes to the Hospital Care Improvement Act (KHVVG) into a three-point plan. At the forefront is the demand that the hospital reform in North Rhine-Westphalia (NRW) be transferred to the federal government without any changes.
“The introduction of the uniform planning concept for 16 federal states is a revolution,” writes the DKG. “In order to be able to take this step, it is essential to implement the individual planning of the state of North Rhine-Westphalia as a common path to transformation.”
The reformed hospital planning in North Rhine-Westphalia was developed and tested jointly by all partners at state level. “And the initial findings show: it is effective,” the DKG emphasizes.
“We call on the federal government to implement this model one by one and thus forego new regulations, for which there is no impact analysis. These include minimum case numbers, stricter staffing requirements or restricting cooperation between hospital sites.”
The hospital reform that began in North Rhine-Westphalia in 2018 is currently in the final stages. The responsible state health ministry recently published preliminary guidelines on how many cases individual hospitals can still handle in the respective service groups.
The federal reform also relies on the introduction of service groups assigned to hospitals, but differs from the NRW model in several respects. Among other things, five service groups are currently being planned that are not foreseen in North Rhine-Westphalia.
Further develop surcharges in the short term
The German Hospital Association is also calling on the federal government to make changes to the future financing of hospitals. “The currently proposed model of reserve financing is not an abolition or overcoming of the flat rate per case,” writes the DKG.
“It is a bureaucratic and undirected system of additional funding through case-dependent reserve funding.” The reserve rate proposed by the federal government is not a guarantee of existence for smaller hospitals, nor is it a de-economization of the system. It does not lead to simplification, but rather to more bureaucracy. Furthermore, there is no planning security with it.
In order to stabilise financing in the short term, the DKG calls for the development of existing caseload-independent surcharge instruments and for the reform of hospital financing to be reconsidered together with the self-government partners.
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Finally, the DKG calls on the government to effectively implement the de-bureaucratisation of the system advocated in the KHVVG. “Real de-bureaucratisation would make a significant contribution to economic stabilisation and a real opportunity to reduce costs,” argues the DKG. However, the measures proposed in the KHVVG would lead to even more bureaucracy.
“We call for the implementation of swift and effective measures to reduce bureaucracy,” the hospital company said. This includes, among other things, suspending minimum nursing staff limits and extending the validity of the OPS structural test to five years. In addition, the structural review, the guidelines for which currently cover 497 pages, should be streamlined.
“The major hospital reform can still be successful,” the DKG emphasizes. “The common framework for hospital planning, combined with the transformation fund, offers the opportunity for a very good hospital structure in the future.”
The DKG’s proposals could lead to a political compromise with which the proclaimed goals of the reform – the concentration of complex services, more outpatient care and comprehensive safety of care – could be achieved. © EB/fos/aerzteblatt.de