G-BA sets minimum quantities for operations on breast and lung cancer
20.12.2021 12:24
When a hospital has routine and experience in breast and lung cancer surgeries, treatment outcomes are proven to be better. To ensure that these particularly difficult and plannable interventions are only carried out at appropriate locations, the Federal Joint Committee (G-BA) set case numbers as so-called minimum quantities at its meeting on December 16, 2021: a minimum quantity of 100 will apply in the future for breast cancer operations and for lung cancer -Operations of 75 per year per hospital location.
In addition, the G-BA increased the existing minimum amount for complex operations on the pancreas from 10 to 20 and in the process also updated the list of operations that fall below the minimum amount. In making its decisions, the G-BA relied on evaluations by the Institute for Quality and Efficiency in Health Care (IQWiG) on the connection between service volume and treatment results, as well as model data analyzes by the Institute for Quality Assurance and Transparency in Health Care (IQTIG) on the question of how many hospital locations continue to participate in the supply if there are different minimum quantity levels and how distances and travel times would be extended.
“Minimum quantities have a very clear and important task: They are intended to ensure that a hospital does not only occasionally carry out complex, technically very demanding and complication-prone operations. In cases of doubt, the lack of routine at one location - especially in interdisciplinary collaboration between different professional groups - can lead to the patient having a lower chance of survival, suffering serious complications or requiring follow-up interventions. For the surgical treatment of breast and lung cancer, there is a scientifically proven connection between routine and treatment results. That's why we have introduced minimum quantities here and defined in detail which services fall under this. “Hospitals must reach these minimum quantities by 2025 at the latest in order to be able to bill the statutory health insurance companies for the operations,” explained Karin Maag, impartial member of the G-BA and chairwoman of the quality assurance subcommittee.
“There were different suggestions within the G-BA as to what level of minimum quantities is appropriate. Because there is always a range of quantities that would generally be suitable to ensure a certain treatment routine. The level of minimum quantities we have chosen ensures that the complex procedures are carried out at a hospital location several times a month. This ensures that there is a sufficient level of routine among the treatment teams, which ultimately guarantees safe and high-quality care. Data modeling was also used to examine how the smaller number of locations affects care close to home: for most patients, the distances or travel times only increase marginally.”
Concentration of breast and lung cancer operations on sites with routine and experience
In 2019, surgical treatments for breast cancer were carried out in 732 of the 1,914 hospital locations in Germany. With the agreed minimum quantity of 100 services per year, the offer is expected to be concentrated at around 355 locations. The average travel time to the nearest clinic increases from 15 to 18 minutes.
Surgical treatment of lung cancer was carried out in 328 of the 1914 hospital locations in Germany in 2019. With the agreed minimum volume of 75 services per year, the range of services is expected to be concentrated at around 90 locations. The average journey time for patients to the nearest clinic increases from 20 to 31 minutes.