The content of the law in detail:
Nursing staff assessment in the hospital
The aim of the law is to improve the care situation in hospitals in the medium term. For this purpose, ideal staffing for the stations is calculated and implemented. For this purpose, an instrument for personnel assessment (PPR 2.0) is used, which was developed by all those involved as part of the Concerted Action on Nursing.
The PPR 2.0 will be introduced in three stages:
The trial phase will start on January 1, 2023 with a practical test. The test phase takes place in a representative selection of hospitals.
On this basis, the hospitals are given specifications for staffing in a legal ordinance.
From 2025, the personnel assessment will then be sharpened and sanctioned.
Hospital day treatment and special sector-equal remuneration
Not every inpatient treatment requires the patient to stay overnight in the hospital. In order to relieve hospital staff more and to enable patients who want this to spend the night in a familiar environment, hospital day treatment is being introduced. Doctors and patients make this decision by mutual agreement. In order to achieve these goals, the documentation requirements for day inpatient treatment should be limited to the necessary minimum.
In the past, whether treatment was inpatient or outpatient was often a question of cost. The different remuneration of inpatient services (flat rate per case) and outpatient treatment (EBM) led to inpatient treatments that were also possible without accommodation in the hospital. In order to avoid unnecessary overnight stays in the hospital for patients, a sector-specific reimbursement will be introduced for certain treatments. This remuneration lies between the outpatient (EBM) and inpatient level (DRG). By March 31, 2023, health insurance companies and hospitals should jointly define a catalog of surgeries that can be performed on an outpatient basis and the corresponding remuneration.
Funding for obstetrics and paediatrics
In order to support obstetric departments in hospitals, the federal states receive additional financial means according to the Königstein key. When determining the specific amount for each hospital location, the provision of a specialist department for pediatrics, a specialist department for neonatology, a certain proportion of vaginal births, the number of births and the possibility of carrying out the practical part of the midwifery course must be taken into account. This is intended to maintain a nationwide supply of obstetrics locations. EUR 120 million is available for this in 2023 and 2024.
For the inpatient care of children and young people, the revenue volume generated before the pandemic in 2019 is largely guaranteed independently of the services actually provided. In order to avoid false incentives, however, a hospital has to accept deductions if it achieves less than 80 percent of the revenue volume for the care of children and adolescents in 2019. The revenue volume from 2019 will also be updated to the present and increased by an additional EUR 300 million for 2023 and 2024 – a total of EUR 600 million. The guarantee of the revenue volume ensures that the care of children and young people is secured against the performance-oriented logic of the case-based flat-rate system. Special facilities can charge a surcharge for the care of children and young people. The funds are earmarked for the care of children and young people.
To finance the additional funds for obstetrics and paediatrics, around EUR 380 million will be withdrawn from the liquidity reserve of the health fund for the years 2023 and 2024. In addition, private health insurance also contributes to the financing.
Safe midwife care
From 2025, midwives’ personnel costs will be fully included in the care budget. This fully refinances the personnel costs incurred by midwives for the care of pregnant women, women giving birth and women who have recently given birth, and the employment of midwives in the delivery rooms is equated with direct patient care on wards with beds.
Further regulations for the hospital sector
In addition, the draft law provides for the following regulations in the hospital sector:
- Budget negotiations for hospitals are accelerated. Deadlines for various procedural steps and automatic action by the arbitration board are specified.
- The structural examination of hospitals by the medical services, the procedure for the transmission of hospital data to the Institute for the Hospital Remuneration System (InEK) and the application procedure for the hospital future fund are also being further developed.
- The liquidity situation of the hospitals is improved by raising the provisional care fee value.
- Telemedical services are promoted by agreeing on appropriate remuneration.
- The hygiene support program will be continued as an infectiology support program and extended by three years so that the staffing in infectiology is financially supported.
- It is guaranteed that the costs of training in nursing care and nursing assistance at the hospital are financed in a legally secure manner.
digital healthcare
The law also contains regulations to improve digital applications in the field of medical and nursing care. The main aim is to improve user-friendliness and increase distribution. In this way, prescription data can be used in the supply process or simple identification procedures in the pharmacies are made possible. At the same time, hurdles that currently exist due to restrictions imposed by providers and manufacturers of information technology systems within the framework of the telematics infrastructure are removed.
Other regulations
- In order to improve the care situation for those affected by long-COVID, the Federal Joint Committee has to make arrangements for cross-professional, coordinated and structured care.
- The equal participation of women on the boards of the Associations of Statutory Health Insurance Physicians and Federal Associations will be strengthened.
- Exceptions for immunoglobulins of human origin from the extended price moratorium are planned.
- With the suspension of the monthly additions to the long-term care fund and the provision of the funds in an annual installment in December 2023, as well as the extension of the federal government’s option to reimburse pandemic-related costs by one year, regulations are being created to stabilize the financial situation of social long-term care insurance in the short term.
- The task of the Advisory Council on Health will be explicitly expanded to include the area of nursing and the report cycle will be made more flexible in order to make scientific policy advice more up-to-date and more tailored in the future.
- Air rescue services are included in the direct sales channel for blood products and can be supplied directly by the blood donation services. This should contribute to improving emergency care for patients.