Great confusion or everything clear?
The new North Rhine-Westphalia (NRW) hospital plan was published in April 2022. The hospital plan forms the basis for comprehensive inpatient medical care in NRW and includes all framework requirements in accordance with the NRW Hospital Organisation Act (KHGG NRW).
At the beginning of the reform planning in the hospital sector in North Rhine-Westphalia, the focus was on two main objectives: Hospitals should have a reliable structural and financial basis in the future. With this structurally reliable financial basis, the best possible medical care for patients should be achieved.
What does future planning look like?
In future, hospital planning in North Rhine-Westphalia will be based on 32 medical service areas (based on the respective further training regulations of the medical associations) and a further 64 subordinate service groups (based on OPS codes, ICD codes and personal or factual quality indicators) as a superordinate medical framework. The latter represent medical services or service clusters. In future, the responsible ministry will determine care capacities based on the service areas and service groups, which will be defined nine per year, taking into account the framework requirements in accordance with Section 13 KHGG NRW.
Based on the regional planning conferences in NRW, it is foreseeable that the hospitals will receive the notifications of allocation according to service areas and service groups in December 2024. The hospitals will receive the care contracts via the designation of the respective service group. If a hospital is allocated a service group, the service area to which this service group belongs is also allocated in the determination notice. The care mandate then comprises the number of cases in a service group, including the respective fluctuation range, which is assigned to a hospital with the determination notice.
What to do in the event of unfavourable decisions?
This inevitably raises the question of how action can be taken against decisions that penalise a hospital because not all service groups have been allocated. As the allocated service groups are due to apply as early as January 2025, haste is required.
Those clinics that are already included in the hospital plan, but are not allocated every requested service group, would have to take legal action to contest this. The problem, however, is that this action has no suspensive effect according to the provisions of the law, with the consequence that parallel measures of urgent legal protection must be taken in addition to the action for annulment.
However, the result in the event of a successful action is probably bizarre.
This is because if the action for annulment is successful, the new benefit group is not automatically assigned. Instead, only the situation that existed before the decision was received will be restored. At that time, however, the benefit group was not allocated.
In order to achieve the hospital’s desired objective, namely the allocation of the service group, it must also be achieved with the respective legal remedy that the authority is obliged to allocate the desired service groups to the plaintiff hospital. However, this objective can only be successful if it can be proven that the legal requirements of the service groups are met in the plaintiff hospital and that the authority’s refusal to allocate the service groups is unlawful.
The assessment notices to be received in December 2024 should therefore be subjected to a thorough examination very quickly so that the right course of action for the correct legal protection is initiated at an early stage.