Making hospital care future proof
The first reading of the Hospital Structure Act by the Bundestag
On 2nd July 2015, the German Bundestag conducted the first reading of the Bill to Reform Hospital Care Structures (the Hospital Structures Act).
“ Patients will continue to be able to rely on receiving a high quality of easily accessible hospital care in the future as well. With the Hospital Structure Act, we will be making significant improvements in hospital financing. Good medical and nursing care can only be provided successfully in hospitals if doctors and nurses are not permanently overburdened. This is why we are allocating 660 million euros, as an emergency measure, to create more than 6,300 new nursing care jobs at hospitals. Moreover, an expert committee is being set up to examine whether increases in the nursing care needs of persons with dementia, persons in need of long-term care or disabled patients, as well as the general care needs in hospitals, are being properly reflected within the framework of the DRGs, or by means of possible supplementary fees.
The Act aims to strengthen the quality of hospital care and improve the financing possibilities available to hospitals. This Act does not require the agreement of the Bundesrat and is scheduled to enter into force on 1st January 2016.
The key elements of the Act:
- The concept of quality is to be introduced as one of the criteria in hospital planning. The provisions governing the minimum number of procedures will be drawn up in a manner that provides legal security, in line with the requirements laid down in the relevant German supreme court rulings. In future, quality-related aspects will also play a role in hospital remuneration. Quality surcharges and discounts for benefits will be introduced. Hospital quality reports will be designed in a more patient-friendly manner as patients require more easily usable information on the quality of the care that individual hospitals provide.
- A nursing jobs funding programme is also being set up, with a view to strengthening direct nursing care for patients. Between 2016 and 2018, funding will amount to some 660 million euros. From 2019 onwards, 330 million euros per year will be made available on a permanent basis. The new jobs created as a result of this measure are to be used exclusively to provide bedside care. Furthermore, in summer, an expert committee comprising practitioners, as well as representatives from academia and the self-administration bodies, will be set up at the Federal Ministry of Health. Its task will be to examine, by the end of 2017 at the latest, whether and how the special care needs of persons with dementia, persons in need of long-term care and disabled persons can be properly accommodated in the DRG system, or by means of supplementary fees. At the same time, its mandate will be to draw up a proposal to ensure that the funds allocated to the nursing jobs funding programme are really used in the financing of nursing personnel.
- With a view to further developing hospital financing, the framework conditions for the deployment of service guarantee incentives have been specified. Hospitals that participate in the provision of inpatient emergency care will receive additional incentives, depending on the emergency structures they maintain. Moreover, in the case of remuneration for outpatient services, the investment deduction for clinics will be halved, from 10 to 5 percent. The framework conditions for incentives for special tasks are to be made more specific. From 2016 onwards, the span of the Land base rates will be narrowed by means of a further approximation to the uniform base rate range.
- The reform of the management of hospital volumes will take place in two phases. In the first phase, the Care Provision Strengthening Act will introduce regulations, effective from 2016, to facilitate the obtention of second opinions in the case of elective interventions that are susceptible to over-provision. In addition, agreements among the contractual parties at federal level will help to reduce the assessment in the case of benefits where the increase in the number of cases is seen to be financially motivated. The second phase will entail a shift in level, for the year 2017, with the management of hospital volumes shifting from the Land to the hospital level.
- A structural fund will be set up to finance measures to improve existing care structures. To this end, a one-time payment of 500 million euros will be made available from the liquidity reserve of the Health Fund. These funds will be used to finance projects proposed by the Laender, if the latter contribute an equal amount. Thus, a maximum of 1 billion euros funding volume will be made available. These funds will benefit hospitals, not instead of, but in addition to, the necessary investment funds.
- The Federal Laender will continue to conduct hospital planning within the framework of the provision of services of general interest and are under the obligation to make available the necessary funds to finance the investments required by their hospitals.
16 July 2016