[Center formation, registries, and quality assurance : Economic impact on training and quality of care]

The increasing tendency toward formation of centers and expansion of quality assurance has had a clear effect on medical education and quality of care in Germany in recent years. On the background of the German diagnosis-related groups (DRG) system and the significant devaluation of DRG codes, this issue should be addressed, particularly in the field of orthopedic endoprostheses.

The effects of center formation and quality assurance on education and quality of care were evaluated based on a middle-sized clinic. In particular, we highlighted the number of training interventions in recent years on the background of the EndoCert initiative.

The costs of complete certification of a hospital according to the KTQ or ISO standard, the expenses for the EndoCert certifications and the EPRD, as well as the continuously increasing personnel demands for registries, quality assurance, and education centers represent an immense economic burden. An improvement in the quality of care can be assumed for the EndoCert Initiative, but this remains without consequence for the revenues situation of the respective cases.

In light of the lack of medical students and in terms of the quality of care in Germany, it must be discussed as to what extent a training-adapted remuneration of clinics is possible. We stress that medical training doesn't only take place in the operating theater and, up until now, has often not been awarded a high priority in the everyday practice of middle-sized clinics across Germany. Since refinancing is not available in the DRG system, in the absence of remuneration of medical education and the different medical center systems, we can expect that affected clinics, particularly those under economic strain, will no longer be able to meet the high demands of modern initiatives.