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You are here: MEDICA Portal. Magazine & More. MEDICA Magazine. Topic of the Month. Volume archives. Our Topics in 2010. July 2010: Quality Management. Health Care Politics.

Exorbitance Creates a Mess

Exorbitance Creates a Mess

Photo: Signs

The certificate seen at a doctor’s office is an after-effect of the obligatory duty of independent panel physicians to practice quality management (QM) in their offices starting in 2010.

The physicians had several years to implement the specifications, which were determined in the directive of the Federal Joint Committee – and since this time, lots has happened. There practically has been a certification boom, and the German medical journal “Deutsches Ärzteblatt” recently even talked about a certification madness.

Physician’s uncertainty and the excessive demands have made it necessary to call legions of consultants into action, who offer their more or less pricey service, and at the end of their job hand out these particular certificates to the physicians, who hang them on the walls of their offices.

The value of these certificates is questionable. To preclude any misunderstandings: There are certainly several certificates, which really live up to their promise, but this is not always the case. The new legal specifications have actually led to the creation of narrow gauge strategies to comply technically with the QM directive. This has nothing to do though with quality management that’s put into practice.

Such certificates are consequently not acknowledged by the Association of Statutory Health Insurance Physicians as proof of quality management compliance. The association rather wants to carry out random controls in the future and request a written voluntary disclosure on QM measures of 2.5 percent of Statutory Health Insurance Physicians. An on-site audit by external experts is not scheduled.

Non-compliance of the special requirements also does not carry any serious consequences. In suspicious cases a counseling interview will be scheduled and that is it. There won’t be any sanctions, because – to quote the KBV - “so far there are no scientific findings on the effectiveness of a facility-internal quality management.“ You could also say, this is because nothing has proven the efficiency of quality management yet.

And so this question should be allowed to ask: Does this enormous effort actually make sense? Isn’t this just a shot in the dark? In a highly ambitious project like comprehensive QM implementation, prospects of success should be somewhat better assessable. If such an enormous effort is carried out, then it should be done with a carefully laid out strategy, where in the end you can safely count on gains in the quality of medical care.

One feels reminded of the chaos with all the guidelines – this was also a major project with the best of intentions. In this case, wishes and reality drifted strongly apart from each other, because activities were not well directed at an early stage and things were given free rein in terms of implementation.

It is always difficult to try to enact service quality “from above.“ You definitely need to proceed in a consistent way, and you need a completely coherent strategy along the way for all stages. If a regulation has slacking reins, like the ones seen in the large-scale project “Quality management in medical practices,“ it is questionable whether its goals will be really reached.

Ulrike Viegener

(Translated by Elena O'Meara)


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