As of: February 16, 2024, 9:39 a.m
By: Stefan Aigner
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There is dissatisfaction in the management team at Regensburg University Hospital due to the situation in the nursing service.
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A loss of 45 million euros for the Regensburg University Hospital was forecast at a board meeting.
“Just a worst case scenario,” it now says.
Regensburg - “According to these forecasts, the UKR will only avoid filing for insolvency because of the guarantee provided by the Free State of Bavaria.” This is what it says in the minutes of a meeting of the board and directors at the University Hospital Regensburg (UKR), in which almost the entire management team took part - 37 people.
The minutes of the approximately three-hour meeting that took place on November 10th last year are available to our editorial team.
Horror forecast at Regensburg University Hospital: “Terrific deficits” and “urgent need for action”
Commercial director Sabine Lange, in office since mid-2020, predicted a loss of 45.68 million euros for 2024 at the meeting and spoke of further “concerning deficits” that would “accumulate” by 2028.
A financial working group, set up by the UKR supervisory board under the chairmanship of Bavaria's Science Minister Markus Blume (CSU), "did not accept the submitted economic plan for the years 2024 to 2028 in this form (...)," reports Lange and warns of "urgent need for action." at.
“Devastating economic situation” for hospitals in Germany
Financial difficulties faced by hospitals are initially nothing unusual.
Rising energy costs, tariff increases, a lack of nursing staff and therefore unusable beds are a few, but by no means all, reasons.
The bureaucracy in view of flat rates per case under abbreviations such as DRG and CMI also causes problems for hospitals.
According to the Bavarian Hospital Society, eight out of ten hospitals expected a deficit in 2023.
According to the German Hospital Association (DKG), over 30 filed for bankruptcy last year.
The DKG forecast 60 to 80 hospital insolvencies for 2024.
Just last September, the Regensburg University Hospital also took part in a nationwide “Red Alert” day of action, where attention was drawn to the “devastating economic situation” of hospitals in Germany.
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45.68 million deficit - that would be a record loss for the UKR
At that time, the UKR leadership made rather general statements, without any direct reference or specifics to the situation in Regensburg or in their own house.
Professor Dr.
Oliver Kölbl, medical director and chairman of the board at Regensburg University Hospital, noted that the services as a “supra-maximum provider” can only be guaranteed with “solid financing”.
Politicians must recognize “that university medicine is not an economic success”.
The figures that Sabine Lange presented at the internal November meeting seem to confirm this impressively.
The forecast deficit of 45.68 million euros would be unprecedented in the history of the Regensburg University Hospital.
The minus from 2019 (13.93 million) and the deficits in the following years, some of which were also double-digit millions, which would have been incurred without Corona aid and special funds, would be exceeded many times over.
Horror forecast at Regensburg University Hospital: increased expenses, lower revenues
“For the current situation,” the protocol mentions in particular a “deviation of 10% between the planned and the actually expected output volume.”
Specifically: Since 2019, the number of operable beds at the UKR has fallen by over 100.
There are also fewer operating theaters.
But the “significant increase in expenses” also gives “reason for concern”.
According to Lange's presentation, the expenditure on personnel and materials is significantly above the median of what is otherwise usual in clinics, including public ones.
Forecast for record deficit: Far beyond the industry median
The commercial director of the UKR uses the so-called productive expenditure ratio as an indicator.
This business key figure is used for the hospital sector in particular by the Munich consulting company Ebner Stolz, whose surveys Lange refers to.
The productive expense ratio summarizes personnel and material expenses and relates them to overall performance.
The lower the ratio, the higher a company's earnings.
If it is 100 percent, this means that the financial proceeds are completely consumed by personnel and material costs - i.e. it is zero.
While the “industry median” for clinics is stated to be between 85 and 90 percent in the presentation, it is put at 101.9 for the UKR 2024 - this means that the operation of the university hospital would be permanently in loss and would be dependent on subsidies or - As the consulting firm Ebner Stolz puts it, there may be “great potential for improvement” here.
Horror forecast at Regensburg University Hospital: You actually need more staff
Accordingly, the minutes also contain the “measures to improve the situation” that are considered “necessary” “as quickly as possible”.
The volume of services must be increased, “optimization potential to increase the number of operable beds” must be developed, and a shift from inpatient services to the less lucrative outpatient area must be avoided.
The aim is to significantly reduce material costs and inventory levels.
But when it comes to the number of employees, which accounts for two thirds of the costs, there is hardly anything that can be changed - on the contrary.
In fact, more nursing staff would be needed.
“Dissatisfaction due to partly dramatic service limitations due to the situation in the nursing service”
If you follow the figures presented in November, the UKR's full-time workforce in health care is roughly at the same level as 2019. In total, just over 3,500 people work full-time at the university hospital - around 680 doctors, almost 900 in nursing.
The number of nursing staff has actually fallen in the last five years.
Compared to 2019, this is only slightly lower – less than three percent among full-time employees.
But, as can be seen from another part of the minutes, there is already “dissatisfaction among the directors at the UKR due to dramatic service restrictions in some cases due to the situation in the nursing service”.
Inquiry at the University Hospital: Isn't it all half as bad?
When we confronted the university hospital with the figures from the minutes available to us, they didn't want to see the situation as so dark.
The board admitted in a lengthy written statement (see below) that the “financial situation of German hospitals, especially university hospitals, (…) has been problematic for years.”
The “complicated and often inefficient financing structure in the healthcare system” is criticized, as are constantly rising costs and the insufficient funding of research and teaching.
On the whole, however, they try very hard to paint a positive picture of the circumstances at the UKR.
It is said that in 2023 we were even “fortunately able to end with a largely balanced economic result”.
Inquiry at the University Hospital: A protocol in which most of the things are not written?
The UKR explains that the minutes of the November meeting paint a completely different picture by saying that - in the interests of the patients - they only wanted to run through “different scenarios of the economic development of our institution for the year 2024”.
“Only the worst-case scenario” was recorded in the minutes of the November meeting, adds UKR board chairman Professor Oliver Kölbl in a personal interview.
The remaining scenarios and, in particular, the necessary changes to avoid the worst-case scenario were “orally discussed and discussed”.
We receive no explanation for the unusual circumstance that these “other scenarios and in particular necessary changes” as well as their discussion and discussion were not included in the minutes.
Inquiry at the University Hospital: Just a “worst case scenario”?
The term “worst case” can be found neither in the minutes nor in the accompanying 26-page presentation by the commercial director.
Ultimately, however, the supervisory board approved an economic plan for 2024, with a deficit in the “low single-digit million range,” which “represents a very good result, especially in Germany-wide comparison, and is also far away from the number you put forward.” it in writing.
Demand at Regensburg University Hospital: More patients, an increase in the base case value and lower energy costs should make everything better
Kölbl explains this turnaround, among other things, by saying that “compared to the previous year, for example, the number of patients treated can now be increased significantly due to personnel reasons, that due to the increase in the base case value, the payments from the health insurance companies will increase, both of which will lead to an increase in revenue, and that the operating costs simply due to falling energy prices.”
We do not receive more precise figures.
Commercial Director Sabine Lange, who is responsible for presenting the economic situation at the November meeting, is not taking part in the conversation with our editorial team.
(By the way: Our Regensburg newsletter regularly informs you about all the important stories from the world heritage city and the Upper Palatinate. Sign up here.)
Horror forecast at Regensburg University Hospital: The responsible ministries are cowering away
An identical request for a statement on the gloomy forecast from November to the three Bavarian ministries of science, health and finance resulted in several calls to our editorial team.
An oral statement from a spokeswoman to the effect that the figures - a forecast deficit of over 45 million - were not available in the ministries and that they could not be understood, was not wanted to be given to us in writing.
Our verbal offer that we would make the minutes available if none of the ministries had them was not taken into account.
There is no comment on the statement documented in the minutes that the UKR avoids filing for insolvency “solely because of the guarantee provided by the Free State of Bavaria”.
Nothing is said about the fact that representatives of the Bavarian Ministry of Science were on the supervisory board when a first economic plan for 2024 to 2028 was rejected.
There is no statement expected for Monday.
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