DGCH welcomes Lauterbach’s reform plans: “Stay brave now”
08.12.2022 10:27
Federal Health Minister Karl Lauterbach has presented his proposals for reforming hospital remuneration. The German Society for Surgery (DGCH) welcomes the plans in principle. “We find it positive that the new remuneration model moves away from pure profit maximization and towards more quality-oriented patient care,” say DGCH President Professor Dr. med. Andreas Seekamp and DGCH General Secretary Professor Dr. med. Thomas Schmitz Rixen. Now the project should not be talked about. “We have to remain courageous and continue on the path. We surgeons support the reform plans and are open to discussions at any time.”
The “Government Commission for Modern and Needs-Based Hospital Care” presented its third statement on December 6, 2022 – the long-awaited “Fundamental Reform of Hospital Remuneration”. The main cornerstones of the detailed 49-page paper are: reducing the weight of flat rates (DRGs) in the financing of hospital services, assuming fixed maintenance costs for hospitals, and aligning the clinics in a three-tier care system and according to service groups. “These are all steps in the right direction, the right approaches,” explains Seekamp. “For us, the quality-oriented centralization of complex services is crucial, something that we have been demanding for a long time.”
Only the classification of the reform project is met with reservations by the DGCH. The Federal Minister of Health originally announced that the DRG system would be completely eliminated. From the DGCH's perspective, Lauterbach is now proposing a further development of the per-case flat rate system, mixed financing from DRGs and reimbursement of fixed costs. “For this reason, one should be careful when using the term 'revolution',” objects Schmitz-Rixen. “It is true that these proposals go further than anything that has been proposed in the last twenty years. But at the end of the day, an implementation over five years is more of an evolution.”
Another important component in hospital reform is outpatient care, on which the hospital commission also issued a statement some time ago. As a result, from January onwards, an estimated twenty percent of the surgical procedures that have previously been carried out as inpatients will gradually be carried out in clinics on an outpatient basis via day treatment. According to the government commission, nursing staff would be relieved of their burden by reducing the need for care at night and on weekends. The DGCH doubts that this calculation will work and considers any savings effect to be unrealistic.
“We would have liked to see a clear analysis of the effects in advance,” emphasizes Seekamp. This also includes the question: How much do clinics and practice clinics have to invest in setting up rooms for follow-up observation and in the personnel structure? And: What happens in the event of complications? Are the costs incurred covered? From the perspective of the specialist society, outpatient treatment will most likely require some readjustments. The DGCH therefore suggests underpinning efforts to redesign the healthcare system with the practical know-how of medical societies and associations in order to find sustainable solutions. “We offer our full cooperation,” emphasizes Schmidt-Rixen.