;Resize=(1200,627)&impolicy=perceptual&quality=mediumHigh&hash=d6199d6db1b44803319993920ab98eabf54a4c89db513c49cda9c8a32a247157 "Lauterbach’s hospital reform under criticism: That’s what experts say")
Germany is threatened with the great death of clinics. That much is clear. Perhaps even one in four of the existing hospitals may soon cease to exist. Federal Health Minister Karl Lauterbach has been warning of this for some time. That is why the planned hospital reform, which the SPD politician describes as “gigantic”, should at least alleviate the drama. He will not close a clinic. But not all would survive the next few years.
Lauterbach specified this in the program “Markus Lanz” and explained more about his plans to save the German health system. ZDF presenter and journalist Cordula Tutt sharply criticized her. Other healthcare experts also see positive points.
These are the basics of hospital reform
On the basis of a Commission paper, Federal Health Minister Karl Lauterbach plans to restructure the hospitals in consultation with the federal states. More specialization, more transparency, more quality – this is Lauterbach’s formula in a nutshell.
The performance groups are a central component of the planned reform. Every case, every operation, every treatment should be clearly assigned to a specific group – on the basis of which the quality goals and requirements for the clinics are defined. The performance groups are linked to quality criteria.
Anyone who does not meet the criteria after a transitional phase lasting several years should not be allowed to provide the service either. The focus is primarily on North Rhine-Westphalia. Comparable performance groups are already being worked out here and are now being tested.
Key aspects of the plans and how professionals evaluate them:
Lauterbach plan: Quality criteria for clinics
This is what the Minister of Health is planning: Lauterbach explains in the program “Markus Lanz”: “This is how we check in every clinic: Who is good at what? (…) The layman must know where it is good and where it is not good.” The results of the quality check are to be published using an interactive map and marked with the appropriate colors.
Lauterbach uses knee operations as an example. “You can click on a map where you want to go with your knee, and then you can see that they do the knee surgery ‘yes or no’ and whether they do the surgery well or not.” The 63 ability groups can be seen. If it can be proven in a facility that the work is done poorly, for example because there are many complications, the federal government can then withdraw benefits in the long term. Scientists would advise them for evaluation. Lauterbach clarified: ” After a transition period, we no longer pay where the quality is poor. “
And further: “We will make that public.” Lanz was surprised: “How now? Seriously?” asked the moderator.
Whether it’s “green” on the map, the quality is consistent, Lauterbach went on to explain. If the signal is “red”, there is a quality problem.
The map is scheduled to be ready by January 1, 2024. According to the Minister of Health, if a house does not deliver good quality in many areas, it will not be able to survive. Journalist Cordula Tutt called this plan the “principle of selection”.
How is the quality actually measured? When asked by FOCUS online, a press spokesman for the Federal Minister of Health has said: “The existing hospitals are currently being categorized according to the planned levels and service groups on the basis of the current quality reports from the hospitals and DRG billing data.” However, the figures would have to be further validated. In addition, the quality criteria would be revised by the medical societies.
What the experts say: Gerald Gaß , head of the German Hospital Society (DKG), which represents around 1,800 clinics in Germany, thinks nothing of “such traffic light systems”. Gass said that before the ZDF broadcast in an interview with the editorial network Germany (RND). And added: ” Lauterbach pretends that you can tell from a few values whether a hospital is good or bad. This is window dressing. The number of possible parameters is so high that it cannot be poured into a simple traffic light system.”
Lauterbach is convinced that quality can be checked easily, as he explained in an interview with “Zeit”. “Unfortunately, I have to disagree,” countered the interlocutor of Susanna John , Chairwoman of the Medical Association Marburger Bund. “Of course you can record how often a certain procedure is performed in a clinic. But it’s hard to say how well it’s done.” Johna explains this using an extreme case: a patient dies after a tumor operation. That’s measurable – but it doesn’t mean the treatment was bad. In a university clinic, for example, particularly serious cases are often treated. For that reason alone, more people die there than anywhere else. “But that doesn’t mean that the university hospital is worse. Medicine is not black and white, there is also a lot of grey.”
But there are also positive voices. “I believe that the reform will bring about a significant improvement in quality in the first place,” judges Christian Karagiannidis , senior consultant and head of the ECMO center and currently a member of the government commission for modern and needs-based hospital care. We would simply have far too many small hospitals. If you don’t have a certain minimum structure, then you wouldn’t get the quality where it should be. Even if the clinic locations were reduced to 1200, Germany would have clinics for almost all diseases within a maximum radius of 30, maybe 45 minutes.
Lauterbach plan: performance groups for hospitals
The Minister of Health is planning: clinics are to be divided into three levels: from basic providers close to home, through a second level with further offers, to maximum providers such as university clinics. In the case of “Lanz”, Lauterbach explained that in future German hospitals should be remunerated accordingly depending on the quality standard. However, not everyone involved agrees with these “levels”. The so-called performance groups are therefore characterized as a classification. They are intended to ensure that the same care with the same quality is offered everywhere. The federal and state governments want to meet again on June 29 for the next and probably decisive advisory round .
“We are tackling the structures with the hospital reform: we assign the hospitals to service groups and look at which hospitals meet the quality criteria. Where they are not met, the federal government then no longer pays,” writes das Federal Ministry of Health on Twitter .
That’s what experts say: The Chief there DKG points out that access to care is also a quality criterion that is measured internationally. “And I think it’s very questionable if Lauterbach has recently started long waiting times so that people end up doing without hip or knee surgery because allegedly too much surgery is being done in Germany,” said Gass in the RND interview. “That is a statement that is unworthy of a health minister.” The health minister had to prove specifically which patients would not necessarily be operated on.
Die President of the Medical Association Johna also addressed the shortage of skilled workers. In her estimation, this will continue to aggravate if the hospital structure changes. More than 20 percent of the beds in Germany could already not be occupied because there is a lack of staff. “For many patients, a longer journey to the clinic may not be a problem, at least if they are not acutely ill. The situation is different for the employees, especially for part-time employees with a long commute to work,” the expert points out. “Before they move to the next hospital, if their clinic has to be restructured or even closed, many will prefer to look for a new job in their region.”
Reinhard Busse Head of the Department of Health Care Management, Technical University of Berlin, and member of the Advisory Board of the Federal Ministry of Health and currently a member of the Government Commission for modern and needs-based hospital care, emphasizes what patients should benefit from in the future: “It should no longer be a lottery where I get there.” Everyone should be able to rely on the ambulance to take him to a hospital that has the appropriate expertise and equipment.