Thousands of heart attack and cancer patients in clinics without adequate equipment

Berlin Health Minister Karl Lauterbach (SPD) recently summarized the precarious situation of the clinics in dramatic words. The system tends towards “cheap medicine”.

Cases would be honored no matter where the patient is being treated, “whether he’s being treated well or not being treated so well.” Small clinics therefore offer operations in order to generate income without coming to the relevant number of cases and the quality.

In its current “Quality Report”, the Scientific Institute of the AOK (WIdO) has surveyed how great the deficit actually is – i.e. how often patients are treated in clinics that are comparatively rarely confronted with cases and in some cases even do not have the necessary equipment.

This is a problem because in clinics with high case numbers, patients die less often, especially with complicated interventions. The report highlighted the clinical pictures heart attack, breast and lung cancer in 2020 throughout Germany. The results can be accessed on an online portal from Tuesday and are exclusively available to the Handelsblatt in advance. There you will find an overview of all treating clinics in Germany.

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The results are sometimes shocking. According to the report, more than 14,000 of the 203,000 patients with a heart attack ended up in a hospital that did not have a cath lab.

In a catheter laboratory, vascular occlusions that occur during a heart attack can be optimally treated. The guideline of the German Cardiac Society recommends avoiding hospitals without such a 24/7 facility.

However, many clinics with low case numbers do not have a cath lab. Of the 362 hospitals that treated fewer than 25 cases in 2020, only one in five had such a laboratory. However, these clinics alone treated more than 4,000 heart attack patients. In contrast, in the clinics with 240 cases per year, each clinic had a cath lab.

“The quality monitor shows that there is a problem in controlling and informing patients, because we actually have no shortage of heart catheter laboratories in Germany,” said WIdO Managing Director Jürgen Klauber.

In 2020 in Berlin alone there were a total of 24 clinics with a cardiac catheter laboratory that was available throughout. Nevertheless, 18 other clinics without a cath lab took part in heart attack care.

Large regional differences – many clinics without quality certificates

In a country comparison, Hamburg fares best, where only two of the hospitals involved in heart attack care did not have a cath lab. This corresponds to ten percent of all institutions.

In addition to heart attack care, the quality monitor also analyzes breast cancer and lung cancer care. “Fortunately, there has been a certain concentration in breast cancer care in recent years,” said Klauber.

The often criticized “occasional surgery” is becoming less, but still has a relevant extent. In 2020, every fifth breast cancer patient was treated in a clinic with fewer than 25 cases per year. In 2016 it was just under one in four.

“You have to keep in mind that 25 surgeries per year correspond to about one procedure every two weeks,” said Klauber. “Under these circumstances, one cannot assume that there is a well-rehearsed team with sufficient routine and a well-rehearsed process chain.”

In addition, not even every second clinic that treats breast cancer cases had a certificate from the German Cancer Society or something comparable. You must have a minimum of 100 cases per year and meet quality criteria. Hospitals that fail to do so treat nearly 15 percent of cases.

And here, too, there are huge regional differences. While in Brandenburg 64.7 percent of the clinics involved in care did not have a certification as a breast cancer center in 2020, all operating clinics in Berlin were able to show such a certificate.

End of the case flat rate: Minister of Health wants to assign clinics to service groups

The clinic reform initiated by Health Minister Lauterbach aims to ensure that in future complex treatments will only be carried out in specialist clinics with a correspondingly high number of cases.

The so-called flat rate per case should be reduced. This involves flat-rate rates for comparable treatments, but without taking the number of cases or the quality of the treatments into account. According to the proposals of a government commission, the clinics should instead be rewarded according to three new criteria in the future: provision of services, levels of care and service groups.

Among other things, fixed amounts should flow for the provision of staff, an emergency room or necessary medical technology. Unlike today, hospitals should also be classified into three specific levels and funded accordingly. The chairwoman of the AOK federal association, Carola Reimann, said the reform proposals would “finally address” the quality problems.

More: Reform proposals are available – Lauterbach announces “a revolution” in the financing of hospitals

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