faq
The nationwide clinical atlas is scheduled to go online today. The Federal Ministry of Health’s directory compares hospitals. What does the portal offer – and what is controversial?
How does the atlas compare the quality of the clinics?
The so-called Federal Clinic Atlas compares the clinics in a region with regard to a specific procedure, such as colon cancer surgery: How often is the procedure carried out in the clinic? Is the clinic certified for this area, i.e. in this case checked by the German Cancer Society?
There is also information about staffing levels. “How high is the specialist key, how good is the nursing key? This is highly relevant information,” says Health Minister Karl Lauterbach about his project.
Complication rates should also be listed. They can provide information about how often a hip implant is incorrect or patients suffer from pressure ulcers.
What is particularly controversial is that the clinics in the atlas are divided into certain levels, which are intended to provide information about the range of services.
Where can I find the portal and what data is already available at the start?
Under www.bundes-klinik-atlas.de The Ministry of Health’s offer can be found here. Not all information will be available there at the start. The page will be filled gradually. Quality seals, for example, still need to be checked before they are all online by 2025. The controversial performance groups are also to be added.
Patients may be confused if they want to distinguish the new portal of the Ministry of Health from other offers – at least if they are simply using Google searches. There are several commercial sites with similar names, such as Klinikradar or Klinikatlas. The hospital association also operates the German hospital directory already an offer.
What are levels and Performance groups?
The portal defines 65 areas of medicine as service groups, such as cardiac surgery, ophthalmology and obstetric medicine. Each hospital is rated based on which of these services it offers.
This determines which level of care, called level, the hospital meets. Level 1 is basic providers. They offer important emergency care, but are not as broadly based. Level 2 clinics offer more, such as at least two surgical areas. For Level 3, clinics must have a wide range available.
Why is this controversial?
The hospital company criticizes that the level classification says “nothing about the quality of the treatment”. “In fact, it will lead to supposed star categories, i.e. levels, misleading patients.” From now on you could prefer the large university clinic. It is feared that the highly specialized department of a smaller clinic could be lost in the transparency portal.
The federal states also see this critically and as an intervention in their hospital planning: actually only as part of the hospital reform planned by Lauterbach will it be precisely defined what service groups are and what levels of care result from this.
The reform, which passed the cabinet in mid-May, is intended to help clinics specialize. Now the Ministry of Health is already dividing the hospital landscape into certain groups without waiting until the entire reform is discussed in the Bundestag and put into effect.
Where does the data come from?
The law stipulates that clinics must report data quarterly. They criticize the high effort. The Marburger Bund medical association speaks of a “further surge in bureaucracy”.
The data is collected by the Institute for Quality Assurance and Transparency in Healthcare (IQTIQ). In addition to clinical data, it also receives information from certification bodies or health insurance companies. For example, it checks the significance of quality seals and certificates and decides what should be published.
How is it ensured that the data is up to date?
Experts assume that the data in the portal will always be around two years old: “In 2024, the latest data available will be from 2022,” says a study by Reinhard Busse, professor of health management at the TU Berlin. It just takes time to raise and examine cases.
But for Busse, this is no reason to doubt the significance of the numbers. He examined how patients fared after hip surgery or a heart attack and whether the clinics had similarly good or bad results two years later. His conclusion: Anyone who does well once will later have “30 to 79 percent better results in the treatment area.”
This means that the older data still predicts treatment success well. There are also increasing complications where there were more problems two years ago.
For which illnesses is it worth it? Clinic comparison?
For many types of cancer, it makes a big difference whether patients are treated in a specialized clinic. This was the result of an analysis by the Government Commission for Hospital Care in 2023. Certified centers achieve better results, especially when it comes to breast cancer and colon cancer.
It is not only important for stroke patients to be treated quickly. It is also crucial that the clinic has a so-called stroke unit. This could mean that 5,000 more patients could survive the first year after a stroke, the study says.
Anyone who needs a hip or knee replacement should also pay attention to how often a clinic carries out this procedure. Experienced practitioners are more likely to be successful during the first operation. Hundreds of follow-up surgeries could be avoided every year if patients choose a clinic whose doctors have a lot of experience with these hip or knee surgeries. The analysis shows this too.
Have hospitals been so opaque so far?
If you want to find out more, you need at least a lot of time. Hospitals currently publish quality reports online, which are often over 1,000 pages long. It says, for example, how high the consumption of disinfectants is in certain wards or how many occupational therapists there are.
Health Minister Lauterbach promises that better clarity and comparability are an advantage of his portal: “You will then see how houses A, B or C compare to each other. This information is currently not available.” The complication rates, which may be of particular interest to many patients, are currently not so easily available and comparable.
To say something Patient advocates to the new offer?
They are skeptical and are worried that in the future clinics will pre-sort their patients in order to present themselves as particularly successful on the portal. Older patients with multiple illnesses would often need longer therapies, which are ultimately less likely to be successful. “This can quickly lead to preferential admission of younger, promising patients and a corresponding inpatient orientation,” says Eugen Brysch, board member of the Patient Protection Foundation. Accordingly, he fears that older and chronically ill people could be discriminated against.
The Ministry of Health rejects such fears. “Methods of risk adjustment are used,” it says somewhat technocratically in an answer to a parliamentary question. This means that age or previous illnesses could be given special consideration when evaluating the data and distortions could be avoided. The ministry promises a “fair comparison”.
Patient advocate Brysch also criticizes the fact that the portal leaves out many things that characterize patients’ everyday lives: long waiting times, a lack of contact persons or the postponement of examinations are also important factors. But such experiences could probably only be included through patient surveys. Ask around among your friends – this will probably further influence the decision for or against a clinic.