Restructuring, mainly in middle management…

Düsseldorf – The allocation of service groups in North Rhine-Westphalia (NRW) is primarily leading to a change in the hospital structure in the semi-specialized area, i.e. in the “middle range” of care. These include elective procedures such as the insertion of artificial knee or hip joints and cancer treatment. This is demonstrated by an analysis of the Scientific Media Center (SMC).

When it comes to primary care, the country in western Germany intends to make few changes in clinics. Even in highly specialized areas, there are only a few changes in performance groups between locations. This is with a already high concentration.

The analysis also shows that it is not possible to identify specific clinic closures due to the distribution of new service groups. “For many hospitals, however, the reform represents a challenge,” writes the SMC.

Because they would have to adapt and possibly severely restrict or expand their existing offerings to meet the new requirements. According to SMC, this also has an impact on the profitability of the clinics.

The allocation of service groups will also lead to a redistribution of patient flows, which could increase competition between clinics, the SMC explained. Clinic staff will also be more likely to gravitate towards clinics with many service groups and high caseloads.

In North Rhine-Westphalia, hospital planning based on the allocation of service groups has been in place for some time. The health associations, the autonomous government and the Düsseldorf State Ministry of Health (MAGS) developed the service groups together in a process that took years.

These are considered a model for the hospital reform planned across the countrywhich is currently being discussed. Performance groups provide precise specifications for technical personnel and equipment. Only those who have been assigned to such a performance group are authorized to provide the corresponding performance. The goal is not only better but also more efficient patient care.

The preliminary decision of the Ministry of Health of North Rhine-Westphalia on the assignment of service groups and approval of specific case numbers has been available since mid-June. Hospitals and health insurers had previously negotiated a corresponding distribution of service groups and the associated number of cases. The hospitals in North Rhine-Westphalia can currently comment on the provisional allocation. A final allocation is expected to be made by the end of the year.

Almost no restrictions on basic services

The decision to approve the requested service groups is mainly taken after the minimum criteria for the service groups have been met. In some cases, higher numbers of cases are approved, for example because another home in the area has closed and neighboring clinics have to absorb the supply. And: About every tenth clinic – out of a total of 553 clinics in North Rhine-Westphalia – receives this SMC Accordingly, more than half of the service groups they applied for were not approved.

The distribution of the service groups for general internal medicine and general surgery shows that basic care should not be severely restricted. Of the 306 clinics that intend to offer general internal medicine in North Rhine-Westphalia in the future, only eleven are not included in the state’s provisional allocation, the analysis tool shows. SMC.

For general surgery, ten of the 285 clinics are not included in the planning. The situation is similar with births. Of the 133 clinics that intend to facilitate births in the future, six will not participate in the service.

The losers include St. Josefs Hospital Hilden and Asklepios Hospital Sankt Augustin, which will not be able to offer all three areas of basic care in the future. St. Johannes Hospital in Hagen, Rahden Hospital or St. Marien Hospital in Ratingen should not be allowed to provide general internal and surgical services.

It is also noticeable that hardly any places for general internal medicine and surgery in urban areas and metropolitan areas are being eliminated. In Cologne and the surrounding area in particular, no places are being eliminated or fewer cases have been approved for clinics than requested. On the other hand, there is the often mentioned criticism that the metropolitan areas of North Rhine-Westphalia are often oversupplied and the rural regions tend to be undersupplied.

Low concentration of pediatric areas

Inpatient pediatric facilities are already relatively sparsely distributed; the state of North Rhine-Westphalia does not plan to concentrate them here. In general pediatric and adolescent medicine, only two of the 71 clinics that applied for care groups will be eliminated. The plan is similar for general pediatric and adolescent surgery. Here, too, only two locations of the 71 clinics applied for will probably not be commissioned.

When it comes to more specialized care and especially elective procedures, future hospital planning will be different. The country wants to focus mainly on the areas of hip and knee endoprosthetics.

Of the 235 clinic locations, only slightly less than half of the clinics (126 clinics) have received permission to use artificial hip joints. Of the 212 clinics for insertion of artificial knee joints, there are also only 126 clinics. MAGS apparently has set a minimum number of 100 cases per year (with isolated exceptions).

What is surprising is that many of these two groups of patients appear to be concentrated in metropolitan areas. In addition, the University Hospital Düsseldorf will no longer be able to provide knee and hip endoprostheses in the future. It had requested 65 or 80 cases and the state did not assign 0 cases.

Deep rectal procedures at least every two weeks

In the group of “deep rectal procedures” services, which require a high level of expertise, only 80 of the 178 clinics were awarded the contract (45 percent). In this group, it is clear that clinics often misjudge the need for such operations, Das writes. SMC.

In the administrative district of Düsseldorf, there is an overall excess demand from the candidate hospitals at the planning level, so that only part of the expected demand can be taken into account to guarantee the supply, the Düsseldorf district government said at the hearing.

Only high-performing clinics that perform such procedures on average at least every two weeks or more frequently were taken into consideration for the provision of the care group. It is also clear that clinics that recently had low case numbers will no longer be expected to perform the care group in the future. Only about twenty cases per year are taken into account in hospital planning (see graph).

Another example that shows a focus on specialist areas is breast cancer treatment. In the future, 75 of the 103 clinic applicants in North Rhine-Westphalia will be able to provide the associated Senology group of services. MAGS has set a minimum number of 100 cases per year. This is in accordance with the regulations of the Federal Joint Committee (G-BA), which requires clinics to perform at least 100 breast cancer surgeries per year starting in 2025.

There should also be a focus on thoracic surgery, for example. Of the 54 clinics requested, one third of the clinics are no longer involved in providing the services (18). MAGS has set the minimum value at 75 cases per year and is therefore also in line with the G-BA regulation on lung cancer surgery, which has been set at this number from 2025.

Organ transplants are concentrated in individual locations

There are also plans to concentrate on organ transplants. In future, only the University Hospital Essen and the Heart and Diabetes Center North Rhine-Westphalia will be able to perform lung transplants.

Two other locations, the University Hospital Cologne and the Municipal Hospital Cologne-Merheim, are not planned for this service in the future. According to the preliminary planning of NRW, heart transplants will only be performed at the Heart and Diabetic Center NRW and the University Hospital Düsseldorf. The university hospitals in Essen, Bonn and Cologne are not planned for this.

In other specialist areas, however, there is hardly any concentration. For example, in the case of cardiac surgery, only one clinical site of the 16 requested clinics will be excluded from care in the future, the University Hospital of Cologne. The country has set a minimum number of 500 treatments per year.

Most clinics should also be authorized to provide services in ophthalmology, skin diseases and sexually transmitted diseases. In ophthalmology, nine of the 48 clinics did not obtain a positive decision and in dermatology only two of the 24 hospitals are not authorized to provide services.

Almost all hospitals in the pediatric hematology and oncology-leukemia and lymphoma care group are also considered for future care. When it comes to pediatric and adolescent cardiac surgery, none of the six registered sites are included. © cmk/aerzteblatt.de