Hospital reform: States threaten to create mediation committee

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Written By Kampretz Bianca

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Kerstin von der Decken (CDU), Minister of Justice and Health in Schleswig-Holstein /photo alliance, Frank Molter

Berlin – If the states’ main demands for hospital reform are not taken into account in the parliamentary process, the Federal Council will turn to the mediation committee. The announcement was made today by the Minister of Health of Schleswig-Holstein, Kerstin von der Decken (CDU), following a federal-state meeting.

She now awaits the parliamentary process. “It is still too early to bury our heads in the sand”, said the president of the Conference of Health Ministers (GMK) today.

The states submitted their declaration with requests for amendments to the Hospital Care Improvement Bill (KHVVG) on time and in a united manner at the end of April. “And to our great disappointment, none of these requests for amendments were included in the bill,” complained von der Decken.

The hospital reform foresees the introduction of 65 groups of services. The objective is to improve the quality of care through national material and personnel criteria. Clinics must meet criteria to be able to provide and bill for services within a specific service group.

Additionally, there must be reserve funding that replaces 60 percent of the diagnosis-related fixed fees (DRG). Funding and performance groups must be interdependent. The third planned change is cross-sector care facilities (formerly Level 1i clinics), which, like small hospitals, are intended to provide an interface between outpatient care and inpatient care.

Federal Health Minister Karl Lauterbach (SPD) today explained to the states which of their demands were acceptable and which would be rejected, von der Decken explained. “What we heard today is relatively disappointing from the country’s point of view,” continued the minister. Among the rejected demands are the states’ main demands, such as more flexible options for planning action groups. This also included more opportunities for clinics to cooperate.

Ensure basic and emergency care in rural regions

Von der Decken is concerned with basic and emergency care in rural areas. In some cases, there are already very few specialized personnel. When questioned, she said that quality requirements within service groups that were too high and could not be met would not improve care. German medical journal. She emphasized that the states do not want to take advantage of exceptions in the groups of activity, but rather use them for the benefit of the population.

Furthermore, Lauterbach rejected the adjustment of planned changes to the remuneration system requested by the states. When it comes to financing the reform, the federal states are calling for smaller hospitals to be given greater consideration.

Lauterbach gave consent for small things, according to von der Decken. The deadlines for carrying out medical service exams should be extended, which could help reduce bureaucracy. He also agreed to involve states in the committee to prepare the planned regulations. According to the law, these should come into force next year and further develop the planned action groups.

The federal states are “16:0”.

Von der Decken was optimistic that as many of the state’s demands as possible would be incorporated into the KHVVG through amendments in the parliamentary process. A first reading is scheduled to take place in the Bundestag before the summer holidays.

If the states’ main demands are not incorporated, there will be a mediation process in the Federal Council, she said. “It can happen quickly if you reach an agreement. But it could also take longer.” On this issue, the federal states are “16:0”. This is remarkable. However, the minister hopes that this will not be necessary. She reiterated that states want and need hospital reforms.

The topic of analyzing the impact of the reform was also on the agenda today. Lauterbach guaranteed that all conditions would be met for this to be done in September. The minister had already announced that the grouping to connect the planned action groups to the DRG would be completed in September.

Von der Decken emphasized that it was irresponsible to implement such an important reform law without examining its impact on the hospital landscape. She expects quick insights. These should also have an impact on the text of the law, says von der Decken. Lauterbach himself did not comment today after the federal-state round.

SPD parliamentary group against exceptions to quality criteria

Headwinds to the exemption criteria required by states came from the Bundestag today. SPD member of the Bundestag Christos Pantazis emphasized that there is a need for nationwide uniform quality criteria in medical care “despite a benevolent review of possible exceptions to the minimum structural requirements”. Quality criteria remain an essential part of the reform because they are of central importance for the health safety of patients.

“In particular, the revolutionary core of this far-reaching hospital reform, in the form of sector-blending care facilities, offers the opportunity to ensure high-quality care in large countries,” said Pantazis. Federal and state governments must recognize this need to work together constructively and drive reform.

The council president called for constructive cooperation between the federal and state governments AOK Federal Association, Carola Reimann, in. There is no need for renovation at any price with high additional expenses that would be distributed according to the watering can principle over a hospital structure that is no longer up to date.

“Instead, the right direction for the development of German hospitals must now be set. They should also be implemented more quickly and consistently than previously envisaged in the KHVVG. To this end, the necessary clarifications must be made promptly in the regulations provided for this”, stated Reimann.

Necessary planning security

She spoke in favor of safety planning and solid funding through fixed reserves for clinics. These should be paid regardless of the number of cases handled and should be based on the needs of the population, says Reimann. She also emphasized: “The quality of treatment must not be left behind in negotiations between federal and state governments, now making questionable compromises.”

Also chairman of the board of Techniker Krankenkasse (T.K.), Jens Baas, complained: “The debate currently only revolves around maintaining hospitals regardless of the real need for care and minimizing the financial burden on states.” quality for patients lost sight of in the political dispute for responsibilities.

“For a better quality of hospital care, we urgently need a better division of labor between hospitals and greater specialization in complex procedures,” said Baas. The originally foreseen quality objectives were relegated to the background in the discussion. The focus of the reform must be the best possible care for people. The federal government should not buy approval from states by committing to uniform quality standards.

Bernadette Rümmelin, managing director of Catholic Hospital Association, now also waits for government factions. This should make Lauterbach relent. The minister’s political “haggling” is keeping clinics in absolute uncertainty about what the future will bring. “The government factions in the Bundestag cannot simply pass the law in the form decided by the cabinet,” demands Rümmelin.

Hospitals ultimately need security in planning and perspective. “In addition to effectively offsetting inflation, this includes the prospect of financial reform that refinances the real costs of maintaining the places that need it. A ‘light per-case flat fee system’ as envisaged in the bill will certainly not alleviate the economic pressure on hospitals,” said Rümmelin. © cmk/aerzteblatt.de

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