Minimum quantities will lead to a significant concentration in complex and high-risk operations in 2024
02.11.2023 16:09
The increase in the minimum quantity for the care of premature babies and newborns weighing less than 1,250 grams from 20 to 25 births per year means that 13 maternity wards nationwide will not be authorized to provide further care in the coming year. According to the AOK's "Minimum Quantity Transparency Map", the nationwide total number of neonatal departments involved in care will then be 144 if the responsible states do not issue any exemptions in the next few weeks. According to the AOK evaluation in 2024, there is also a clear concentration of care for most other interventions relevant to minimum quantities.
“Concentrating care on clinics with high case numbers is good news for the survival chances of very small premature babies. The scientific studies clearly show that with a higher number of cases, the complication rates and the risk of death for the children treated are lower,” emphasizes Jens Martin Hoyer, deputy chairman of the AOK Federal Association. “The decision of the Federal Joint Committee to increase the minimum quantities is now having an effect – and that makes absolute sense in terms of patient safety.” However, it is possible that individual maternity wards were still authorized to provide care by the responsible state authority despite the minimum quantity being fallen short of. “These locations are then added to the AOK map, but with a special color code and an indication of the most recently reached number of cases,” says Hoyer.
Minimum amounts have the desired effect
The clearest concentration will take place next year “Minimum Quantity Transparency Map” in complex operations on the esophagus: After the number of clinic locations involved in care had already been reduced by a third in the last decision-making round, it will fall again by a quarter in 2024 - from 147 clinic departments with permission for the esophagus -OP on 111 departments in the coming year. For complex procedures on the pancreas, 46 locations have to be removed from care - a decrease of 11 percent. “Here, too, the effectiveness of the minimum quantity regulations is clearly evident, because for pancreas operations the final increase in the minimum quantity to 20 procedures per year will not take effect until 2025. However, many clinics are already voluntarily withdrawing from the care because it is becoming apparent that “They cannot meet the necessary requirements,” explains Jens Martin Hoyer. When it comes to liver transplants, the number of clinic locations authorized to carry out operations falls from 20 to 18 (minus 10 percent), and for stem cell transplants from 92 to 72 (minus 22 percent). However, the decline in this indication is mainly due to the fact that the minimum amount previously applied to allogeneic and autologous stem cell transplants, but from 2024 it will only apply to allogeneic transplants.
While there was an increase of 6 clinic locations this year in the number of clinics with permission for the implantation of total knee joint replacements, the number will fall from 938 to 903 next year (minus 3 percent). There is no change in kidney transplants, which can continue to be carried out at 36 locations.
New minimum quantities for breast cancer and lung cancer operations
Two newly introduced minimum quantities will take effect for the first time next year, the effects of which will also be reflected in the “Minimum Quantity Transparency Map” shown: For the surgical treatment of breast cancer, a minimum number of 50 cases per year will apply from 2024, which will then be increased again to 100 cases per year in 2025. For the coming year, a total of 425 clinic locations in Germany have received permission to carry out breast cancer operations. “It is good that the minimum quantity after the increase in 2025 will be at the level that the German Cancer Society requires for the certification of a clinic as a breast cancer center. “The number of clinics authorized to perform surgery will then probably be reduced by around a fifth, based on the currently reported number of cases,” said AOK board member Hoyer. “The patients benefit from the concentration of these operations, because the minimum case numbers demonstrably ensure more routine and experience in the surgical teams, fewer complications and a higher chance of survival for the women treated.”
Also new is the minimum volume for thoracic surgical treatment of lung cancer in adults, which will be 40 cases per year in 2024. On this basis, a total of 169 clinic locations have received a positive prognosis and thus a permit for surgery in the coming year. A further increase in the minimum volume of lung cancer operations to 75 cases per year in 2025 has also been set.
“Minimum Quantity Transparency List” lists 1,075 clinic locations
In total, the AOK's online map for next year lists 1,075 clinic locations that have received permission to carry out minimum quantity-relevant procedures with particularly high risks for patients. It will be continually updated if there are any changes. Since 2019, the “Transparency Map” has provided information about the effects of the annual decisions of the regional associations of health insurance companies on the particularly difficult and risky treatments for which the minimum amounts currently specified by the Federal Joint Committee (G-BA) apply.
Since 2019, clinics that want to carry out procedures relevant to minimum volumes have had to inform the health insurance companies at the state level in the middle of each year about their current case numbers for the last year and a half and provide a forecast for the following year. On this basis, the regional associations of health insurance companies decide whether to accept the hospital's prognosis and grant permission for surgery for the following year. The reported case numbers for each individual clinic are recorded in the AOK map. This information is an important indication for patients who are about to undergo planned operations and for referring doctors. Hospitals that have fallen below the minimum quantity in the past, for example for organizational or personnel reasons, can also receive a positive forecast. The information from the “Minimum Quantity Transparency Map” are also included in the AOK health navigator and are displayed there to users after entering a relevant treatment in the hospital search.
Joint Federal Committee discusses additional minimum quantities
There are currently legally stipulated minimum quantities for the implantation of artificial knee joints (50 cases per year), liver (20), kidney (25) and stem cell transplants (25 cases per year, 40 cases from 2025), complex operations on the esophagus ( 26) and the pancreas (15 cases per year, 20 cases from 2025) as well as the care of premature and full-term babies with an intake weight of less than 1,250 grams (25 cases per year). From 2024, the minimum quantities will also apply for the first time for breast cancer operations (50 cases per year, from 2025 100 cases) and for thoracic surgical treatments for lung cancer (40 cases per year, from 2025 75 cases). The Federal Joint Committee is currently discussing the introduction of additional minimum quantities for carrying out heart transplants and colon cancer operations. There will also be discussions about updating the existing minimum quantity for implanting artificial knee joints.