/ image alliance, Bernd von Jutrczenka
Berlin – There is resistance from several states ahead of the Bundestag’s decision on hospital reform tomorrow. North Rhine-Westphalia and Schleswig-Holstein in particular threatened to appeal to the Mediation Committee (VA) of the Federal Council and thereby temporarily block the law. The East German countries also formulated resistance. The Bundestag is expected to pass the KHVVG tomorrow after years of deliberation.
In a paper written six days ago, the East German state explained that recent changes in the Hospital Care Improvement Act (KHVVG) plan cannot guarantee comprehensive hospital care.
The states of Saxony, Thuringia, Brandenburg and Saxony-Anhalt consider the deficiencies so serious that “without further adjustments, an appeal to the Department of Veterans Affairs should be recommended to avoid serious structural consequences,” the paper said. German medical journal (AND) available.
“I would recommend calling a mediation committee,” said Schleswig-Holstein Health Minister and Chair of the Conference of Health Ministers (GMK), Kerstin von der Decken (CDU) today AND.
And North Rhine-Westphalia’s Health Minister Karl-Josef Laumann (CDU) said yesterday in a letter to health ministers: “Given the existing situation, I would suggest to the North Rhine-Westphalia state cabinet to try to pass the law through a mediation process in terms of security of supply.”
The letter is there AND before. Laumann criticized the lack of planning sovereignty and the state’s lack of knowledge about planned financial reforms.
However, not all health ministers are willing to call a mediation committee. “For Lower Saxony, I agree with the current hospital reform changes,” said Lower Saxony Health Minister Andreas Philippi (SPD). AND.
Philippi and the East German federal states touched on recently proposed amendments that make further changes to the KHVVG. “The crucial question for the mediation committee emerged after analyzing the group’s performance with grouper fish. “This analysis will show how the law will be needs-based,” continued Philippi.
The hospital reform provides for 65 service groups, which in the future will determine national structural specifications for staff and technical equipment. In future, retention benefits should reach 60 percent of the previous diagnosis-related fixed rate (DRG).
Additionally, cross-sector care facilities are planned to ensure care close to home. These measures aim to centralize and specialize clinics to improve the quality of patient care.
Federal states should be able to check their projects using simulation models
Federal states must now be provided with simulation models to analyze the impact of reforms before a Federal Council decision is taken. This is based on an initially uncertified grouper fish that is being developed by the Hospital Remuneration System Institute (InEK). This grouper should be able to assign all inpatient cases to 65 service groups.
States should be able to use this tool to analyze their reform plans, for example how many service groups they want to divide into how many hospital locations. Planned financing changes must also be checked. A decision in the Federal Council and a possible appeal to the KHVVG Mediation Committee are expected on November 22.
During a government hearing in the Bundestag today, Federal Health Minister Karl Lauterbach (SPD) expressed confidence that the Federal Council would not summon a mediation committee.
He pointed out that the reforms would overcome the fixed fee system regarding diagnosis, improve services in rural areas and ensure specialization. “Therefore, I am confident, based on these factual arguments, states will positively support reform.”
He further explained that currently an impact analysis is available. The minister emphasized that states, for example, can see exactly which performance groups are distributed and how they are distributed in their federal states. It is an instrument that can be used to take hospital planning to a new level.
Key demands from states have not been met
“We need reform, but good reform. We don’t have it yet,” said Minister von der Decken today. “I note that the states’ key demands have not been met.”
This includes, for example, adequate transition funding until reforms are implemented, greater reductions in bureaucracy, and reliable funding to guarantee basic and emergency services in the region, said von der Decken. He also saw that the protection of state planning sovereignty was threatened.
Laumann also criticized this. He criticized the fact that the state’s main criticism of hospital reform “received little response” in the Federal Ministry of Health (BMG). Still, Laumann acknowledged in his letter to his colleagues that the amendments that became known in recent days would make the law better.
The East German states wrote in their paper that only two of the eleven federal states’ demands were included in the KHVVG changes. This includes coordination functions for maximum service providers, not just university hospitals, for service networks and relaxation of specialist requirements within planned service groups.
East German states also criticized other points such as exceptions to quality requirements for performance groups or insufficient transition funding.
Submit impact analysis in a timely manner
Von der Decken also stressed the need for timely delivery of impact analysis. “Even if the necessary instruments were actually presented, none of the professionals involved could assume that a serious impact analysis could be carried out in a short time,” complained von der Decken.
German medical journal print
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But Laumann also acknowledged that in the future states will be able to decide on the allocation of service groups and which medical services should be offered at which hospitals and to what extent.
The allocation of the number of cases will have an impact on the financing of each hospital. “This means that countries are given much greater responsibilities than they currently have. “I firmly assume that we are all happy to assume this responsibility,” Laumann said.
At the end of last year, the Federal Council contacted the Mediation Committee regarding the first component of hospital reform, the Hospital Transparency Act. This meant the enactment of the law was delayed for months. After negotiations in a mediation committee, the federal and state governments approved the law.
In return, the federal government promised financial stabilization for the hospital, which is now included in the KHVVG. This includes, for example, retroactive adjustments to state base case values as well as future increases to state base case values so that clinic operating costs can be better reflected in cost increases. © cmk/aerzteblatt.de
