Hoyer: “Many clinics are leaving voluntarily”

“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.

>> In total, the AOK's recently published online map (1) lists 1,075 clinic locations for next year that have received permission to carry out minimum quantity-relevant procedures with particularly high risks for patients. It is continually updated
lised if there are any changes. The publication is based on Section 305 Paragraph 3 SGB V (individual AOKs) or Section 305 Paragraph 3 in conjunction with Section 214 Sentence 2 SGB V
(AOK Federal Association).
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 G-BA apply. The online map makes it clear, among other things, that the clearest concentration in the coming year will be 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 in 2024 by a quarter - from 147 hospital departments with permission for esophagus surgery to 111 departments in the coming year. For complex procedures on the pancreas, 46 locations have to be removed from care - a loss of 11%.
“Here, too, the effectiveness of the minimum volume regulations is clearly evident, because for pancreas operations the final increase in the minimum volume 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 are “We cannot meet the necessary requirements,” explains Jens Martin Hoyer. For liver transplants, the number of clinic locations authorized to operate falls from 20 to 18 (-10%), and for stem cell transplants from 92 to 72 (-22%). 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 in the number of clinics with permission for the implantation of total knee joint replacements this year, the number will fall from 938 to 903 next year (-3%). There is no change in kidney transplants, which can continue to be carried out at 36 locations.
Two newly introduced minimum quantities will take effect for the first time next year, the effects of which are also shown in the “Minimum Quantity Transparency Map”: For the surgical treatment of breast cancer, a minimum quantity of 50 cases per year will apply from 2024, which will then be raised again to 100 cases per year in 2025 becomes. 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 also 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 patient
“Insiders benefit from the concentration of these operations, because the minimum number of cases demonstrably ensures more routine and experience in the surgical teams, fewer complications and a higher chance of survival for the women treated.”
Transparency only through comparison

The exciting question remains as to where all the hospitals are that are not meeting the minimum quantities either now or in the foreseeable future. At the request of “Monitor Healthcare Research”, the AOK Federal Association announced that the AOK minimum quantity transparency card only shows those clinics that have received a positive prognosis from the regional health insurance associations and thus a permit for surgery for the procedures subject to minimum quantities have received. Since services do not have to be reimbursed by the health insurance companies if a clinic carries out these operations without having a “surgical permit” for the year in question, it cannot be expected that the procedures relevant to the minimum quantity will be carried out at other locations. If you want to know which clinics will have to withdraw from care in 2024 compared to 2023 because they remain below the minimum quantities, you can compare the maps from 2023 and 2024.
This is what “Monitor Healthcare Research” did for the example of the development of hospitals that are allowed to carry out complex interventions on the esophagus organ system. The maps of the AOK's “minimum quantity transparency maps” for the years 2021 to 2023 show the effects of increasing the minimum quantities to 10 (until 2022) and 26 from 2023. The Institute for Quality Assurance and Transparency in Health Care (IQTIG) had previously commissioned the G -BA calculates that the new location distribution will affect the routes the patients travel. According to the scientific analysis available to the G-BA, a longer route would “not pose any risks for care, as these are only operations that can be planned and not emergencies”. <<
by: MVF editor-in-chief Peter Stegmaier