Clinic boss raises the alarm: "Hospitals need financial first aid now"

Created: 2022-12-19 2:22 p.m

By: Dieter Dorby

Benjamin Bartholdt, Director of Agatharied Hospital.

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Too little money, too little staff, hardly any capacity: Germany's clinics are sounding the alarm.

The Federal Ministry of Health in Berlin recently responded - Minister Karl Lauterbach announced a hospital reform.

The principle: relocate more, relieve more, organize more.

Agatharied

– In the Agatharied Hospital, keep a close eye on which direction the journey should take.

Not much concrete has been heard so far, says clinic director Benjamin Bartholdt: “So far we only know that the new concept should have four central pillars.”

According to Bartholdt, the first pillar provides for proportionate advance financing.

This loosens the principle of case flat rates - the so-called DRG, the diagnosis-related groups, i.e. diagnosis-related case groups (we reported).

This classification system was introduced in 2003 by the then Federal Health Minister Ulla Schmidt (SPD) and provides for a flat-rate billing procedure.

This means that the hospitals are paid a flat rate according to the diagnosis.

The Agatharied hospital runs 24 hours a day, 365 days a year – and that costs money.

Funding from the healthcare system no longer has the right answers to some developments.

© THOMAS PLETTENBERG

Bartholdt describes the problem with the DRG case flat rates as follows: “Currently, the money follows the service.

However, the clinics have had large fluctuations in capacity utilization, especially since Corona.

For example, beds had to be kept free for infectious patients.

This means that there is also a lack of sales to pay for the upkeep costs.

Pre-funding would relax this mechanism.

In the future, clinics could generate 40 percent of the DRG revenues by maintaining their offer.

The result would be better financial planning.

The federal government controls the clinics

The second pillar - and this is the first downer in Lauterbach's approach - is more planning by the federal government.

That would intervene in the clinic planning, which has so far been a matter for the federal states.

"The federal government would then prescribe which services which hospital is allowed to provide," explains Bartholdt.

So far, the departments at the clinics have been relatively free.

In future, the spectrum would then be precisely specified on the basis of individual performance groups.

According to Bartholdt, that would be a shift from market economy to planned economy elements in the system.

Outpatient before inpatient

The third pillar provides for more outpatient treatment and fewer inpatient stays.

This should relieve the nursing staff by fewer overnight stays.

Economically, this means less income for the clinics.

You are already prepared.

"We already work according to three guidelines: conservative before operative, outpatient before inpatient, and the earliest possible discharge of the patient according to medical criteria.

That's the best thing for patients and finances.

“The patients then come back and are usually in worse shape.”

Reorganization of very small clinics

Bartholdt sees the Agatharied hospital less affected by the fourth pillar, because it regulates the reorganization of very small clinics with between 100 and 150 beds.

Agatharied, with its 350 beds, would be a long way from that, says Bartholdt, "but houses with up to 150 beds will have a hard time".

A reduced medical presence would save money, and locations would also be up for discussion.

"This political process will be hotly debated," predicts Bartholdt.

The conversion is expected to take five years, and it will “cost money”.

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Money is the main problem.

Because, as Bartholdt notes, the existing healthcare system is simply being rebuilt.

"The money is being redistributed, but no additional money is coming into the system." In addition, the financial situation is now a burden on the clinics - but the reform will only take effect in the future.

"We have an acute emergency phase," warns Agatharied's board.

"The clinics need first aid now."

For his hospital, Bartholdt sees advantages in the forthcoming financing from the emerging reform, with Agatharied being particularly affected.

“We are in a tourist region.

30 percent of our patients come from outside.” This in turn means large fluctuations in occupancy.

He is also concerned about a possible loss of services, such as surgery in the area of ​​major pancreatic surgery.

Bigger doesn't mean more quality

Bartholdt is skeptical about the principle of the new reform: “It takes quality as an argument.

The quality should improve if services are bundled and centralized at locations with large volumes.

But that doesn't have to be the case.

Sometimes the opposite is also the case.” Otherwise, small bakeries would not be able to produce better goods than large companies.

But it is precisely the large centers that the committee around Lauterbach is aiming for.

"Ultimately, it's about the money." And who will ultimately be among the winners or losers of the reform is currently open.

When it comes to financing, another weakness of the DRG principle is becoming increasingly burdensome: "The amount of the flat rate per case lags behind the annual development of material costs and tariffs," says Bartholdt.

"The height doesn't fit anymore."

Even with the investments, the financial framework no longer meets the requirements.

“The Free State of Bavaria has around 640 million euros per year in its budget for investments.

That sounds like a lot.

But that is put into perspective when you know that it was a similar amount in 2000.

And back then we were still writing with typewriters.”

In the meantime, medical and IT technology is on a different level, everything has evolved.

"The reform must also take this into account." In North Rhine-Westphalia, a doubling of the investment budget is currently under discussion.

Bartholdt: "I would also like that for Bayern."

ddy