Natascha C Nüssler1, Thomas Klier2, Reinhard Ruppert2. 1. Klinik für Allgemein‑, Viszeralchirurgie und Coloproktologie, München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, München, Deutschland. natascha.nuessler@muenchen-klinik.de. 2. Klinik für Allgemein‑, Viszeralchirurgie und Coloproktologie, München Klinik Neuperlach, Oskar-Maria-Graf-Ring 51, 81737, München, Deutschland.
Abstract
BACKGROUND: The increase of minimum volumes for complex esophageal resections decided by the Federal Joint Committee (GBA) in Germany is currently the subject of intensive discussions. OBJECTIVE: To shed light on the effects of minimum volume requirements from the perspective of a tertiary care hospital. RESULTS: Strict adherence to the valid minimum volume requirements for esophageal surgery would significantly reduce the number of hospitals offering these procedures in Germany. The associated loss of revenue should not have any relevant negative economic consequences for most hospitals; however, the loss of complex esophageal surgery may result in a competitive disadvantage for these hospitals in times of shortage of qualified medical personnel. Another point of criticism is the assumption that the treatment quality can be recognized based solely on the numbers of patients. CONCLUSION: Despite the well-known volume-outcome relationship, minimum volume requirements do not define the lower limit of quality of surgical treatment. Therefore, additional evidence of treatment quality, such as structural or process quality as well as outcome parameters should be required, e.g. through certification. An obligatory synchronous certification could contribute to increasing the acceptance of minimum volume requirements in Germany.
BACKGROUND: The increase of minimum volumes for complex esophageal resections decided by the Federal Joint Committee (GBA) in Germany is currently the subject of intensive discussions. OBJECTIVE: To shed light on the effects of minimum volume requirements from the perspective of a tertiary care hospital. RESULTS: Strict adherence to the valid minimum volume requirements for esophageal surgery would significantly reduce the number of hospitals offering these procedures in Germany. The associated loss of revenue should not have any relevant negative economic consequences for most hospitals; however, the loss of complex esophageal surgery may result in a competitive disadvantage for these hospitals in times of shortage of qualified medical personnel. Another point of criticism is the assumption that the treatment quality can be recognized based solely on the numbers of patients. CONCLUSION: Despite the well-known volume-outcome relationship, minimum volume requirements do not define the lower limit of quality of surgical treatment. Therefore, additional evidence of treatment quality, such as structural or process quality as well as outcome parameters should be required, e.g. through certification. An obligatory synchronous certification could contribute to increasing the acceptance of minimum volume requirements in Germany.
Authors: Ulrike Nimptsch; Thomas Haist; Christian Krautz; Robert Grützmann; Thomas Mansky; Dietmar Lorenz Journal: Dtsch Arztebl Int Date: 2018-11-23 Impact factor: 5.594