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Berlin – The members of the Federal Joint Committee (G-BA) have raised the care of premature and full-term babies to a new standard of quality and will require hospitals to more strictly adhere to minimum nursing staffing levels starting in 2027.
The quality assurance guideline, which has now been further developed in terms of content, was primarily based on the current guideline “Recommendations for the structural requirements of perinatological care in Germany” of the Working Group of Scientific Medical Societies (AWMF) referenced.
In addition, the conclusions of the “clarification dialogue” process, which is conducted with clinics that fail to meet the minimum requirements of the guidelines, were included, the G-BA announced after the meeting.
At yesterday’s plenary session, members approved a draft resolution submitted by the three arbitrators. According to impartial chairman Josef Hecken, there had previously been no agreement in the quality assurance subcommittee on the new version of the directive, resulting in more than 300 points of disagreement.
This apparently included not only content-related debates, but also editorial debates on grammar and comma placement, Hecken explained at the beginning of the discussion. The possibility for arbitrators to develop their own draft resolutions and submit them to a vote in such cases has existed since 2019.
The proposed guidelines aim to impose sanctions from 2027 if minimum requirements, for example for nursing staff, are not met. The G-BA stresses that the directive would make staffing requirements more flexible and at the same time more specific.
The technical specifications of the current guideline with the highest level of recommendation are adopted by the guideline as minimum requirements based on the respective level of perinatological care, the G-BA announced.
If clinics violated this policy from 2017 onwards due to staff shortages, their remuneration would be deducted proportionately. The G-BA emphasises that billing is “exact to the day”, as arbitrator Karin Maag explained. The situation is different with the “additional quality requirements”: failure to comply with the additional quality requirements is recorded, but does not lead to loss of remuneration.
Discussion on sanctions
The discussion at the G-BA plenary session arose especially with regard to sanctions and the secondment of nursing staff: the president of the German Hospital Association (DKG), Gerald Gaß, stated that as a result of the directive, more hospital directors from level 1 hospitals – perinatal centres – would withdraw from care.
The threatened sanctions of receiving full DRG payment for a day without sufficient nursing staff and the complete loss of the corresponding care allowance are no longer acceptable to many CEOs.
He believes that once the facilities are closed, nursing staff will not be able to travel to other locations, which will then have to care for more patients. This creates waiting lists that should not arise in the case of premature baby care, says Gaß.
He also explained that the AWMF guidelines, on which the G-BA guidelines are now based, were interpreted too broadly. The G-BA resolution quality requirements went far beyond the requirements that scientific societies consider necessary. He therefore called for the decision to be reconsidered and reconsidered.
Neither representatives of health insurance companies nor patient representatives could follow this argument. Doris Pfeiffer, CEO of the National Association of Statutory Health Insurance Funds, explained that the guidelines set minimum requirements and that these would be developed in the G-BA for care. She argued that the penalties, which clinics were not supposed to face until 2027, should be applied earlier.
The patient representatives also demanded the following: “Quality assurance is always controversial. The aim here is to make something transparent that the stakeholders do not want to be so clearly visible,” said the quality assurance spokesman for the patient representatives at the G-BA, Wolf-Dietrich Streiter.
In the plenary session he also said clearly: “If parents knew how much depends on the good care of premature babies, they would accept completely different ways of getting good care. He demanded clearly that there must be consequences for clinics, which did not meet staffing requirements.
“Nursing staff need to be trained. I would like countries to have to prove what they are doing to train staff.” He also called for the sanctions on clinics to come into force much earlier, without the planned transition period. In the vote, health insurers voted in favor, arbitrators and the DKG voted against.
In the vote on the directive as a whole, the arbitrators voted in favour of the health insurers and against the DKG. After the decision, she once again clearly criticised the vote in a statement.
“In the medium term, the revision of the quality assurance guidelines for premature and full-term babies endangers the current good care provided to premature babies in Germany compared to international standards,” said Gaß. The quality requirements are “small-scale in the sense of the GKV” and are taken to the extreme with “very high financial penalties”. He sees the “medical guidelines of the AWMF as being misused and misused as a sanctioning instrument”.
The federal states, which were not personally present at the meeting, also shared the DKG’s argument and called for the directive not to be voted on in this way. The Impartial Hecken quoted the email in which the states explained their decision: They also fear that the number of perinatal centres will decrease and the centres that remain will become increasingly larger. The limits on nursing staff cannot be met and the existing staff will not be moved. © bee/aerzteblatt.de