Hospital reform: States want clear rules for cross-sectoral providers

Berlin. The German states and the federal government remain at odds on numerous points regarding the Hospital Reform Adjustment Act (KHAG). The 68-page statement from the expert committees reveals the diversity of the ongoing conflicts. The Federal Council will decide on the final statement on November 21.

The states are particularly dissatisfied with the regulation concerning cross-sectoral care providers (SÜV) in Section 115g of the German Social Code, Book V (SGB V). They argue that there has been no progress in this area compared to the Hospital Care Improvement Act (KHVVG). However, they maintain that such facilities represent "an essential component of the hospital reform, the success factors of which have so far been insufficiently considered."

The conversion of smaller hospitals into regional centers could make a "significant" contribution to securing healthcare provision in rural areas. This requires a "viable nationwide framework." The Health Committee justifies its demand by stating that regional centers can only fulfill this role in the transformation process "if their range of services can be adapted to regional needs as a flexible toolkit."

Reduce the complexity of compensation

The states are seeking simplifications, particularly regarding service provision and billing. Their core aim is to eliminate the requirement that services in outpatient care facilities must be provided in independent nursing units that are financially separate from the hospital. This, they argue, would significantly reduce the complexity of reimbursing such facilities.

Closely related to this is the request to establish medical and nursing care as a service within the statutory health insurance system – a corresponding clause was still included in early drafts of the Hospital Financing Act (KHVVG) . This addresses the care needs of a growing number of elderly and multimorbid patients, for whom medical care must be combined with nursing support.

Existing services such as transitional and short-term care do not adequately meet the care needs of these groups. Medical services within the framework of medical and nursing care could be prescribed by contracted physicians or arranged by hospitals, according to the federal states.

Additional performance group required

Further demands from the states:

• Attending physician care: Currently, the requirement for an attending physician department is to have the equivalent of three attending physicians. This is considered "impossible" to achieve in rural regions, such as Mecklenburg-Western Pomerania, and would effectively end attending physician care there. The availability of one attending physician would be sufficient if the hospital planning authority defines the scope of services narrowly.
• Additional service group "Newborns in Maternity Clinics": The background is a gap in the service group system, with the consequence that purely maternity clinics that do not meet the quality requirements cannot be assigned the service group Perinatal Focus (Level 3). The facilities cannot bill for these DRGs, which leads to significant revenue losses.
• Reversal of the funding cuts in 2027: The planned cuts to funding for stroke units, specialized traumatology, and intensive care in 2027 would result in a shortfall of €363 million nationwide. The funding should be granted "regardless of the postponement of the standby compensation."
• Redesign of the standby compensation: From the states' perspective, the new standby compensation creates "new incentives for underperformance and insufficient services." Furthermore, the calculation methodology promotes an imbalance between service groups: The economic pressure to be assigned only "lucrative" service groups runs counter to the goal of "ensuring comprehensive care through de-economization." Instead, the standby compensation should be "calculated largely independently of the scope of services provided."

The Bundestag will debate the KHAG (Housing and Healthcare Services Act) for the first time on Wednesday evening. Committee deliberations will begin afterwards. The law is scheduled to come into force at the beginning of next year. (fst)