The Federal Joint Committee (G-BA) and Quality Assurance in Health Care
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1 The Federal Joint Committee (G-BA) and Quality Assurance in Health Care The Hague, 18. November 2010 Dr. Dorothea Bronner Chief Executive Director Federal Joint Committee (G-BA)
2 The Federal Joint Committee (G-BA) Established 2004, but predecessor committees dating back to the 1920s Main decision-making body of the so-called self-governing system of the German health care system Charged with health policy-making within a legal framework Commissioned by law to issue legally binding directives Service providers (physicians, dentists, hospitals), health insurance funds (sickness funds) and patient representatives are members of the G-BA.
3 The German health care system and the G-BA Framework for health care: Legislation established by the parliament Decrees issued by the Ministry of Health Directives issued by the G-BA under supervision of the ministry of health (MoH) Contracts between self-governing organizations under supervision of the federal MoH or the state ministries
4 Legal Status of the G-BA
5 What does the G-BA do? The G-BA issues directives and thus determines the benefit package of the statutory health insurance covering about 70 million people: Ambulatory and hospital care Dental care, psychotherapy Diagnostic and therapeutic procedures and interventions Pharmaceuticals, Vaccines and Medical Devices In addition, the G-BA has important responsibilities regarding quality assurance for in- and outpatient care and in developing disease management programmes for chronic diseases.
6 Tasks include evidence-based coverage decisions regarding innovations - outpatient care: inclusion and exclusion of services - hospital care: only exclusion of services disease management programmes for chronic diseases pharmaceuticals - exclusion of prescription drugs (if there is no additional benefit) and of life-style drugs - reference-price setting - OTC exemption list - therapeutic advice - off-label use - cost-effectiveness analysis
7 What does the G-BA NOT do? Contracts between single payers (e.g. sickness funds) and providers or manufacturers Regulation of premiums Risk adjustment among the sickness funds Payment of doctors Determination of the amount paid for procedures, interventions or pharmaceuticals Determination of DRG s
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11 Der G-BA Aufgaben,
12 Committee Structure
13 Co-operation with the Institute for Quality and Efficiency in the Healthcare System
14 How the G-BA works Application commission Directive MoH objection approval IQWiG external institutes Working Commitee Report and recommendation Publication / release Important criteria: -effective -necessary -efficient assessment appraisal
15 Quality assurance and measurement Since 2004 the G-BA is authorised by law to issue the guidelines and procedures for quality assurance and measurement (in- and outpatient care) Up to 2008 guidelines and procedures for quality assurance and measurement where defined either for in- or for outpatient care Forced by law the task was then to set up guidelines and procedures sektorenübergreifend to enable quality data from different treatment episodes and service providers An independent institution had to be mandated to support the G- BA with scientific expertise In 2009 AQUA was commissioned by contract with development, measurement and implementation of quality assurance procedures
16 Co-operation with AQUA Federal Joint Committee Development, measurement and implementation of quality assurance AQUA-Institute (Institute on Applied Quality Improvement and Research in Health Care) Following patients over space and time : quality data from different treatment episodes and service providers
17 137 SGB V External Quality Assurance Programme (outcomes) Quality Report (hospitals) Minimum Requirements for Structure and Process (in- and outpatient care) Continous Medical Education (hospital doctors) Requirements for internal Quality Management Minimum Volume Requirements
18 Directives for Quality Assurance (1) 1. Autologous chondrocyte implantation in the knee joint (ACI) 2. Matrix-associated autologous chondrocyte implantation in the knee joint 3. Proton therapy of inoperable hepatocellular carcinoma 4. Proton therapy of prostate carcinoma 5. Paediatric cardiac surgery 6. Minimum volume requirements 7. Quality assessments magnetic resonance tomography (MRT) 8. Quality assessment radiology 9. Quality assessment arthroscopy 10. Quality management for hospitals 11. Quality management for medical practice (office-based doctors) 12. Quality management for dentists
19 Directives for Quality Assurance (2) 13. Quality audits / inspections for medical practice (office-based doctors) 14. Chronic renal dialysis 15. External Quality Assurance Programme in hospitals 16. Abdominal aortic aneurysm (structure/process) 17. Paediatric oncology/haematology (structure/process) 18. Positron Emission Tomography (PET) in Non-Small Cell Lung Cancer 19. Proton Therapy of Rectum/Rectal Carcinoma 20. Neonatal intensive care services 21. Hospital quality reports / public reporting 22. Continuing Medical Education (hospital doctors) 23. External, data-based follow-up quality assurance 24. Directive for spezialised outpatient services in hospitals
20 20 Paediatric Cardiac Surgery Patients up to the age of 18 suffering from congenital or acquired cardiac diseases Requirements for hospitals such as Number and qualification of staff (e.g. physicians, nurses, other therapists) Infrastructure (e.g. Imaging, diagnostics, intensive care unit, ) Availability of services (e.g. daily, on weekdays) Frequency and tasks of team meetings and quality circles (e.g. patient information, recommendations for standard operating procedures, )
21 21 Paediatric Oncology Patients up to the age of 18 suffering from paediatric-haemato-oncological diseases Requirements for hospitals such as Number and qualification of staff (e.g. physicians, nurses, other therapists) Organisation (interdisciplinary tumour conferences) Technical equipment and facilities (availability of laboratory, imaging diagnostics, pharmacy ) Participating in studies to optimize therapies
22 Minimum Volume Requirements Minimum volumes per year and hospital: Liver transplantation: 20 Renal transplantation: 25 Complex oesophageal surgery: 10 Complex pancreatic surgery: 10 Stem cell transplantation: 25 Total knee replacement: 50 Coronary surgery: not yet Neonatal care for very low birth weight neonates (< 1250g): 30 Evaluation of the directive
23 Public Reporting Information on services and outcome data of hospitals: Since 2005 all hospitals in Germany have been required by law to publish a quality report every two years. Aims of these reports are e.g.: to inform patients and doctors about hospital specialities and capabilities, to present hospital performance and quality data to the public, to provide a basis for benchmarking, The directive defines: the procedure of report preparing and publishing the content, scope and data format of these quality reports (e.g. kind and number of medical services provided, continued medical education, ) Abbildung folgt
24 External Quality Assurance Programme in Hospitals Measuring quality using quality indicators followed by a peer review process for 30 services/diseases, e.g.: - Pneumonia - Aortic valve surgery - Cholecystectomy - Obstetrics - Gynaecological operations - Implantation of pacemaker - Heart transplantation - Hip replacement - Carotid artery surgery - Breast cancer surgery - Liver transplantation - Renal transplantation - Combined heart- and lung transplantation - Neonatal care
25 Chronic Renal Dialysis Objectives: Transparency and evaluation of quality assurance data in institutions for chronic dialysis treatment Defines: Evaluation criteria for dialysis treatment Sampling (documentation, data security, analysis and evaluation) Duty to participate in a quality assurance programme (benchmarking)
26 Continuing Medical Education for Hospital Doctors and Psychotherapists Defines the requirements for continuing medical education e.g.: Scope and time frame (250 points within 5 years (thereof at least 150 points in areas specific to actual patient care) Certificates Duties of hospital administration (documentation and reporting)
27 THANK YOU! Dorothea Bronner Chief Executive Director Federal Joint Committee (G-BA) Wegelystr Berlin dorothea.bronner@g-ba.de Internet:
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