Lauterbach offers countries Jour Fixe for hospital renovation

Berlin – Federal Health Minister Karl Lauterbach (SPD) is offering the states a Jour Fixe to discuss hospital reform. He explained this to the Federal Council today.

Lauterbach explained that all state premiers and health ministers could contact him directly in this consultation every two weeks without registration. He does not want there to be any more misunderstandings in the discussion about hospital reform. With this proposal, Lauterbach is apparently trying to accommodate the states.

Today they made it clear again before the state house that, in their opinion, the current draft of the Hospital Care Improvement Act (KHVVG) will not achieve the agreed reform goals. They threatened again to convene the mediation committee. This approach would significantly delay the reform timetable.

The hospital reform envisages the introduction of 65 service groups that aim to establish uniform quality and equipment criteria throughout the country. The federal states should be able to assign service groups to hospitals as part of their hospital planning.

The plan is to eliminate casual care and improve the quality of patient care. In addition, reserve funding of 60 percent of total operating costs is to be tied to service groups. The remainder will continue to be funded through diagnosis-related fixed fees (DRGs).

Cross-sectoral care facilities are also planned to ensure basic services, especially in rural regions. The KHVVG is currently under discussion in the Bundestag. The public hearing in the Health Committee is scheduled for 25 September. The reform is expected to come into force on 1 January 2025.

The current version of the KHVVG should be rejected, said Brandenburg Health Minister Ursula Nonnemacher (Greens). She criticized the uniform federal requirements for not being adequate to take regional characteristics into account when it comes to the planned performance groups. Nonnemacher called for practical options for cooperation and binding and permanent exemptions from performance groups in sparsely populated areas.

Completely excessive staffing requirements

The KHVVG project has “serious weaknesses”, emphasized Bavarian Health Minister Judith Gerlach (CSU). From the state’s point of view, the reform process was “worrying”. For them, it is important to supply the population close to home. She also demanded that there be more exceptions to the criteria for performance groups.

Gerlach criticized the current KHVVG regulations as a threat to the structure of cooperation and alliances that have been built up in recent years. She further criticized the “completely excessive staffing requirements” for some service groups, particularly in the area of ​​pediatrics. There are structural requirements here that some clinics simply cannot meet due to a shortage of qualified workers. As a result, Gerlach fears that clinic locations will be eliminated.

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

Hospitals that receive safety surcharges would not have to meet the service groups’ quality criteria in the future and would still receive the planned reserve budgets, Lauterbach explained. This is happening permanently, “because we absolutely have to preserve the houses,” he stressed. When this regulation was implemented, scientists cried foul because of the deviation in quality, Lauterbach said.

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

In response to criticism about the excessive staffing requirements in the performance groups, Lauterbach replied that the three specialists provided for in most performance groups could be counted for three different performance groups. “That is the absolute minimum. If we refrain from doing this, we can save the specialist standard,” Lauterbach emphasized.

Municipalities support hospitals with millions

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

For a timely reform, serious and sound advice from the states must be taken into account, Weil stressed. He reiterated the demand from the states for an impact analysis of the reform. “Countries cannot be expected to buy a pig in a poke,” Weil said. 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 grouping, which links the performance group system to the diagnosis-related flat-rate (DRG) system, is complete, Lauterbach explained. That was the case in September, which is why the analysis was always announced for September.

However, such an analysis also assumes that the states would assign the performance groups to the locations. In North Rhine-Westphalia, for example, an analysis could be carried out because a few weeks ago the state assigned 60 of the 65 planned service groups to hospitals after a reform process that lasted several years. Lauterbach called on the states to carry out appropriate tests.

Weil also criticized the planned regulation on the transformation fund, saying countries would only be able to receive new money for hospital restructuring as part of the reform. Weil complained that this would penalize countries that have already committed to adapting structures now or in recent months. “That cannot be intentional.”

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

Weil and Bavarian Health Minister Gerlach, among others, also clearly criticised the fact that specialist clinics will in future have to offer groups of services in internal medicine, surgery and intensive care medicine.

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

It is necessary to reduce bureaucracy instead of creating it

For Schleswig-Holstein’s Health Minister and Chairwoman of the Conference of Health Ministers (GMK), Kerstin von der Decken (CDU), interim funding for hospitals is necessary until the reform comes into force. Bureaucracy needs to be reduced rather than increased. “A third of the bill consists of testing and reporting obligations,” she criticized. She also insisted on a retention allowance that is independent of the number of cases.

If the changes requested by the states do not happen, they will meet in the mediation committee, warned Health Minister Manne Lucha (Greens) from Baden-Württemberg. Thuringia’s Health Minister Heike Werner (Die Linke) also said: “There does not have to be a mediation committee, but if the interests of the states are not taken into account, we will have to talk about that too.” The GMK chairwoman from the ceiling had similar feelings. already announced a few weeks ago.

The states also agreed today on some concrete proposals to improve the KHVVG. For example, the Federal Council refuses to allow the transformation fund to be financed by contributions from those with statutory health insurance. Instead, the federal subsidy to the Health Committee should be increased with appropriated funds in order to prevent those with statutory health insurance from being disadvantaged, according to a recommendation.

As for the transformation fund, the catalog of eligible measures is also too narrow. States are requiring that all projects to concentrate acute inpatient care capacity across all locations be included in the catalog.

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

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

With regard to cross-sectoral care facilities (level 1i clinics), the federal states also require that these cannot simply be converted from existing hospitals, as Lauterbach also described.

They should also be 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 unit, this should not depend on whether or not there is a transformable hospital in the relevant region.” © cmk/aerzteblatt.de