Nursing staff strengthening law
| Basic data | |
|---|---|
| Title: | Law to strengthen the nursing staff |
| Short title: | Nursing staff strengthening law |
| Abbreviation: | PpSG |
| Type: | Federal law |
| Scope: | Federal Republic of Germany |
| Issued on the basis of: | Art. 74 para. 1 nos. 12, 19, 19a GG |
| Legal matter: | Social law , health law |
| Issued on: | December 11, 2018 ( Federal Law Gazette I p. 2394 ) |
| Entry into force on: | 1st January 2019 |
| Weblink: | Text of the law |
| Please note the note on the applicable legal version. | |
The law to strengthen the nursing staff , including nurses-Support Act (PPSG), regulates in Germany among other things, adjustments to the Hospital Financing Act (KHG) and Hospital Remuneration Act (KHEntgG) the remuneration of inpatient services provided by hospitals and day-care services. The aim is better staffing and better working conditions in nursing and care for the elderly . The German Bundestag approved the law by a majority on November 9, 2018 and the Bundesrat on November 23, 2018. It came into force on January 1, 2019.
The measures of an emergency care program planned by the federal government are implemented in it.
Care budget, care revenue catalog
In 2019, in a transitional phase, the previous foster care funding program in the hospitals is to be further developed, in which every additional position created and every increased care position at the bed for immediate patient care will be fully financed in accordance with Section 4 (8) KHEntgG. The prerequisite for this is the hiring of staff above the average number of full -time employees (VK) or by increasing existing part-time positions compared to the previous year. There is no upper limit.
From 2020, a dedicated nursing budget will be established to finance personnel costs in accordance with Section 6a of the KHEntgG. The nursing budget will be negotiated in the summer of 2019 by the German Hospital Association , the National Association of Health Insurance Funds (GKV) and the Association of Private Health Insurance (PKV), and in autumn 2019 the nursing income catalog and the shares in the DRG system reduced by the nursing staff costs will be added from 2020 Section 17b (4) of the Hospital Financing Act (KHG) agreed. In the event of deviations between the negotiated care budget and the actual personnel costs, compensation is made in the care budget for the following year.
For the first time in Germany, the DRG system introduced in 2003 with the diagnosis-related case groups will be significantly changed. The hospital reimbursement will be converted to a combination of flat rate per case and nursing staff cost reimbursement. The outsourcing of nursing staff costs from the DRG leads to an earmarking of approximately 25% of the previous DRG revenues. The care budget is then paid off using a hospital-specific care fee. This is calculated by dividing the annually agreed care budget by the probable sum of the valuation ratios (relative weight; CW) for the agreed year determined according to the new care revenue catalog according to § 17b paragraph 4 sentence 5 KHG .
The basis for the personnel costs for the nursing staff (health and nursing care) of all hospitals are the full-time positions in nursing with and without direct employment with the hospital as shown by the Federal Statistical Office in the series 12 series 6.1. The reported full-time positions in institutions of psychiatry and psychosomatic medicine as well as in hospitals without a supply contract must be deducted from these full-time positions.
Nursing staff who do not work directly on the care bed, for example in functional service or in the medical-technical area (e.g. in the areas of anesthesia, operating theater, radiology, endoscopy), are not fully financed.
Savings in nursing staff costs can be taken into account when creating additional nursing-relieving measures in the nursing budget from 2020 according to Section 6a (2) sentence 7 KHEntgG up to approx. 550 to 600 million euros per year. This does not include dismissal of nursing staff at the bedside, but measures to relieve the burden of care, such as the assignment of certain activities to other groups of people such as service staff or care assistants (food supply, linen supply, bed transport), pharmaceutical-technical assistants for drug administration, mobilization by physiotherapists , technical innovations such as the digital patient file and care cart, care robots , etc.
Nursing staff quotient, care expenditure catalog
With the Nursing Staff Strengthening Act (PpSG), a new § 137j SGB V was added, which provides for the determination of a nursing staff quotient for each approved hospital, which is intended to relate the staffing with full nursing staff to the nursing effort. This is to create a lower limit for improving the nursing staff and ensuring the quality of nursing care, which the hospital must not fall below. It is made up of the full nursing staff employed in bedside care in relation to the hospital's care expenditure.
The Institute for the Remuneration System in Hospitals (Inek) will determine and compile an annual catalog for risk adjustment of the care expenses from May 31, 2020. On the basis of this catalog, the sum of its valuation ratios (cost weights, CW) is calculated for each hospital . However, the personnel quotient is listed without reference to the qualification level or the actual assignment of tasks of the nursing staff.
Hospital Structure Fund
With the Nursing Personnel Strengthening Act (PpSG), the hospital structure fund introduced in 2016 by the Hospital Structure Act will be extended until 2022 and up to around one billion euros will be available for structure improvement measures. The federal states bear half of the sum. In particular, this should reduce overcapacities, concentrate hospital locations and convert hospitals into non-acute inpatient local supply facilities (e.g. health or care centers, inpatient hospices) or contribute to improvements such as the formation of integrated emergency structures, telemedicine or IT security.
Fixed cost degression deduction
The fixed cost degression deduction (FDA) in hospital financing, also introduced in 2016 by the Hospital Structure Act, which usually leads to a fixed cost degression with every increase in volume, was extended by three years with the Nursing Staff Strengthening Act (PpSG) and has now been set for the first time at a nationwide deduction of 35%. The amount of the fixed cost degression deduction was previously determined by the negotiations of the self-government in the respective federal state. Transplants, multiple trauma and the care of severely burned people, premature babies and DRG services with a material cost share of over 66 percent are not affected by discounts.
Nursing staff lower limits (PPUG), care-sensitive areas
The Nursing Staff Lower Limits Ordinance of October 5, 2018 ( Federal Law Gazette I, p. 1632 ) introduced a minimum staffing level in nursing-sensitive areas of hospitals in accordance with Section 137i SGB V from 2019. The Nursing Staff Lower Limits Ordinance was revised on October 28, 2019 ( Federal Law Gazette I p. 1492 ). The ratio of the number of patients to one nurse is specified or updated therein. This initially affected the areas of intensive care , geriatrics , trauma surgery and cardiology , from 2020 also cardiac surgery, neurology, the neurology-stroke unit and neurological early rehabilitation in day and night shifts. There is also a percentage upper limit for the share of nursing assistants (PHK). The care-sensitive areas are determined by the Institute for the Remuneration System in Hospitals (Inek) on the basis of the data from 2017 and the diagnosis-related groups (indicator DRGs) included.
However, this does not apply to every hospital, since the basis is the data transmitted in 2017 from a specialist department to the institute for the hospital remuneration system . The proportion of indicator DRGs in the total number of cases in this specialist department must be at least 40 percent. For example, intensive care units must have at least 400 cases with an operation and procedure key code (OPS) of the intensive care complex treatment.
The lower thresholds for nursing staff are derived on the basis of the so-called percentile approach. The lower limits are currently based on around 25 percent, which means that around a quarter of the hospitals have not yet achieved this target. Reimbursement discounts for hospitals that fall below the lower limit will apply from April 2019. Compliance is determined by monthly average values and determined by a mandatory separate PpUG verification agreement.
Ratio of the number of nursing staff lower limit (PPUG) and the maximum creditable share of nursing assistants (PHK) (non-certified nursing staff) according to § 6 PpUGV:
| Care-sensitive area | PPUG 6:00 am-10:00pm | PPUG 22: 00-06: 00 | PHK 6:00 a.m. - 10:00 p.m. | PHK 22: 00-06: 00 |
|---|---|---|---|---|
| Intensive care | 2: 1 (formerly 2.5: 1) |
3: 1 (previously 3.5: 1) |
8th % | k. B. (previously 8%) |
| geriatrics | 10: 1 | 20: 1 | 15% (previously 20%) |
20% (previously 40%) |
| Trauma surgery | 10: 1 | 20: 1 | 10% | 15% |
| cardiology | 10: 1 (previously 12: 1 |
20: 1 (previously 24: 1) |
10% | 10% (previously 15%) |
| Cardiac surgery | 10: 1 | 20: 1 | 5% | k. B. |
| neurology | 7: 1 | 15: 1 | 10% | 8th % |
| Neurology stroke unit | 3: 1 | 5: 1 | k. B. | k. B. |
| Neurological early rehabilitation | 5: 1 | 12: 1 | 10% | 8th % |
The table shows the values valid from January 1, 2020, the information in brackets relates to the period before; k. B. stands for no consideration of PHK. For the specialist departments cardiac surgery and neurology , minimum staffing levels were not set until 2020 (the specifications for cardiac surgery, neurology, neurology, stroke unit and neurological early rehabilitation in the PpUGV 2018 did not yet contain any specifications for cardiac surgery, neurology, neurology, stroke unit and neurological early rehabilitation).
At the first drawing of hospitals according to According to Section 137i (3a) SGB V on January 29, 2019 for nationwide data acquisition of the care-sensitive areas in the hospitals, the Asklepios Clinic Harburg and the municipal clinic Dortmund were the only two hospitals with five separate care-sensitive areas. This is followed by 14 hospitals, each with four care-sensitive areas for data collection (University Clinic Aachen, Clinic Aschaffenburg-Alzenau, Central Clinic Bad Berka, St. Josefs Hospital in Bochum, GFO Clinics Rhein-Berg in Bergisch Gladbach, the Municipal Clinic Braunschweig, the Municipal Hospital Dresden-Friedrichstadt Clinic, the St. Georg Clinic in Leipzig, the Emscher-Lippe Catholic Clinics in Gladbeck, the Helios Clinic Berlin-Buch, the Oldenburg Clinic, the Ludwigshafen am Rhein Clinic, the Nuremberg Clinic - North and South, the hospital of the Merciful Brothers in Regensburg)
Health Minister Jens Spahn suspended the lower nursing staff limits at the beginning of March 2020 in view of the COVID-19 pandemic in Germany until further notice. In the areas of trauma surgery, cardiology, cardiac surgery, neurology, stroke units and neurological early rehabilitation, this should remain in place until December 31, 2020; the lower limits previously set will apply again from August 1, 2020 for the areas of geriatrics and intensive care.
criticism
In February 2019, the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), the German Society for Neurointensive and Emergency Medicine (DGNI) and the German Society for Neurology (DGN) criticized the new guideline values for nursing staff, as they are not based on the actual Aligned patient care needs. For neurological intensive care units, they recommend consistently the personnel key of one nurse for the care of two patients. The planned creation of new care positions and the specification of lower limits alone could not solve an improvement in quality or the significant relief of the care workers, since there are currently not enough care workers on the market to meet the demand.
Individual evidence
- ↑ https://www.bundesgesundheitsministerium.de/sofortprogramm-pflege.html
- ↑ https://www.g-drg.de/Pflegepersonaluntergrenzen/Umsetzung_der_Verordnung_zur_Festlege_von_Pflegepersonaluntergrenzen_in_pflegesensitiven_Bereichen_in_Krankenhaeusern_PpUGV
- ↑ §6 PpUGV 2018
- ↑ https://www.g-drg.de/content/download/8126/60422/version/1/file/PPUG_Ziehung_gem_Par_137iAbs3a_SGB_V_%C3%9Cbersicht_gechte_Krankenh%C3%A4user_2019.pdf
- ↑ DKG on the suspension of lower nursing staff limits: Hospitals welcome ministerial initiative. German Hospital Association (DKG), March 4, 2020, accessed on March 7, 2020 .
- ↑ The ministry is partially reinstating the lower threshold for nursing staff. In: Deutsches Ärzteblatt. July 21, 2020, accessed July 31, 2020 .
- ↑ https://www.dgni.de/presse/681-vorgabe-von-untergrenzen-ist-keine-geeignete-loesung-zur-entspannung-der-personalleistungs-in-der-pflege.html
See also
- Hospital funding
- Hospital Remuneration Act (KHEntgG)
- Nursing Strengthening Acts (PSG)
- Nursing staff regulation (PPR)
Web links
- Official basic information on the law. In: DIP documentation and information system for parliamentary processes. German Bundestag, 2018.
- Statements of the associations on the law. German Bundestag, 2018.
- Website of the Federal Ministry of Health on the law. Federal Ministry of Health, November 9, 2018.
