“The reform is unavoidable for the preservation of our healthcare system.”

ARTIQO: The hospital reform in North Rhine-Westphalia is being closely watched nationwide. As head of orthopedics and trauma surgery, how have you experienced the change process so far?

Dr. Dohmen: We’ve reached a stage in Geilenkirchen where we can finalize our future plans. We’ve received our key performance indicators (KPIs) for all orthopedic service groups. For us, as a maximum care provider, this is a favorable situation, as we are permitted to continue offering the full spectrum of orthopedic services. The KPIs essentially correspond to our application and our expectations, so we can now prepare to deliver these service volumes.

ARTIQO: What impact do you foresee in the regional environment in the Heinsfeld district and the surrounding areas?

Dr. Dohmen: In the region, we only see three providers that can offer the full range of orthopedic services. Then there are a few hospitals that are authorized to perform a certain number of primary hip replacements. The situation regarding knee replacements is currently unclear for us. We assume that some providers will close down completely. We can’t yet estimate to what extent smaller providers will be allowed to remain in the market.

We are a region with few hospital beds. This fundamentally represents a more dramatic disruption to the regional hospital landscape than I had anticipated.

ARTIQO: The discussion raises concerns that concentrating services in these centers might result in insufficient resources to provide necessary interventions without waiting times or overburdening the existing structures. What are your thoughts on this?

Dr. Dohmen: We fear that the poorly paid revision surgeries will accumulate at our center. Currently, we perform 100 revisions per year. Perhaps we’ll end up with 200-300 revisions? That would be a significant workload that we couldn’t manage effectively, either in terms of time or cost. There will also be increased patient referral to specialized centers for primary joint replacements.

It’s too early to say for sure. We’re currently observing that smaller providers are still trying to secure their market share through advertising, likely hoping to gain a stronger negotiating position.

ARTIQO: In endoprosthetics, we have long been discussing minimum case numbers that demonstrably contribute to improving the quality of care. The DGOOC’s EndoCert certification also requires this. The consequence of this is also the formation of specialized centers. Will this really change so much for endoprosthetics?

Dr. Dohmen: That’s correct. Nevertheless, the providers’ distress is understandable. Many hospitals are deeply in the red or on the verge of collapse. If a service category that has guaranteed stable revenues is now eliminated, these hospitals will face massive financial problems. And this applies to the entire hospital, not just the affected service category. We also have a very significant cross-subsidization system with other hospitals, which maintains healthcare provision in rural areas.

ARTIQO: What do you say about the NRW reform: Is it a thumbs up or a thumbs down?

Dr. Dohmen: The current hospital structure is no longer sustainable for a variety of reasons. We have too many inpatient facilities and a large number of dilapidated hospital structures. In the outpatient sector, we lack effective structures that could handle this volume of services. Something urgently needs to be done.

Then let’s look at the endoprosthetics companies: The industry has suffered greatly in Germany because the cost pressures from hospitals were passed on to the manufacturers. The price level is simply unsustainable for the companies. This is unacceptable. We have always been very innovative in this field, and we are now jeopardizing our future.

Demographically, we are also heading for disaster because we simply cannot find the personnel to provide the services in the future. Many of us who, like myself, perform high volumes of endoprosthetics today will retire in the next two to ten years. This worries me personally: Who will treat me later?

To answer your question: I hope that the reform will be implemented as currently planned. I believe this is right and unavoidable for the preservation of the healthcare system. And I hope it won’t be watered down by the usual lobby groups.

ARTIQO: Now the question is: What will happen at the federal level? Before the summer recess, Ms. Warken announced a “further development law” for the Hospital Care Improvement Act (KHVVG) of 2024. What do you expect?

Dr. Dohmen: I think that the North Rhine-Westphalia model could, in principle, be transferred to the other large federal states. Whether that would also work for the city-states, I can’t say.

Ich gehe aber davon aus, dass Bayern die vollständige Übertragung des Laumann’schen Ansatzes auf den Bund verhindern wird und ein eigenes Modell favorisieren wird.

Ich habe Frau Warken bereits zwei Mal getroffen. Sie ist eine gute Zuhörerin und auch, wenn Sie fachfremd ist, sind ihre Ministerialbeamten noch dieselben. Sie werden den eingeschlagenen Weg mit Anpassungen weiterverfolgen und den Ländern mehr Mitspracherecht zubilligen.

ARTIQO: What is your conclusion so far regarding the NRW reform?

Dr. Dohmen: For me personally, this means I have to work and plan very effectively for a very long time. For the company, it means we have to adapt very dynamically to the changes. And we have a duty to manage our finances in order to guarantee people reasonable services in the future.