In the run-up to the twice-yearly Members’ Assembly in Berlin, we speak to Prof Dr Heyo Kroemer, CEO of Charité – Universitätsmedizin Berlin and the serving EUHA president. On November 10th, Charité – Universitätsmedizin Berlin will host the representatives from each EUHA member, including their CEOs and EUHA Steering Committee members, at the upcoming EUHA Member’s Assembly.
In an interesting conversation with Heyo, he reflects on the challenges and opportunities that lie ahead for EUHA and Charité and provides an overview of his presidency, which is set to conclude at the upcoming Assembly, after which EUHA’s presidency will transition to Karolinska University Hospital.
What are the greatest challenges that Charité is confronted with?
The two greatest challenges are demographic change and medical progress. The two are external and lead to a challenging situation, due to economic pressures and limitations in current healthcare systems. While we have limited control over these challenges, we can influence some areas. This includes the timely recruitment of skilled workers and digitising tasks that don’t require human intervention.
Another major challenge is the DRG per case system, which reimburses hospitals with a fixed price per case for each diagnosed-related group category (DGR). While high inflation and rising personnel costs have led other businesses to raise their prices, we as hospitals are bound by insurance reimbursement systems based on salary agreements and prices before COVID-19. At the same time, we cannot raise our patient numbers due to the shortage of workforce. That is why around two thirds of university hospitals in Germany are now in the red. I am firmly convinced that university medicine will no longer exist in its current form in ten years’ time if the system remains as it is.
University medicine will no longer exist in its current form in ten years’ time if the system remains as it is. Prof Dr Heyo Kroemer
University medicine will no longer exist in its current form in ten years’ time if the system remains as it is.
How are you addressing these challenges in Germany and at Charité?
The German government is addressing these challenges with several reforms. One is aimed at coordinating the different levels of care to adapt to demographic changes.
We will lose a significant portion of our workforce to retirement in the next ten years. According to the Federal Statistical Office, Germany had 1887 hospitals in 2021, many of which are smaller than 100 beds. Unless these hospitals are very specialised, they will no longer be economically viable. Larger hospitals with larger infrastructure, on the other hand, can do things more cost-effectively. Furthermore, several indicators demonstrate that hospitals performing certain operations more frequently tend to achieve better outcomes Thus, a second cornerstone of the reform is improving quality.
University hospitals are to take on a coordinating role in the reforms. With the reform, sixty per cent of the DRGs per case are going to be translated into advanced flat rates. The question is how the advanced flat rates are distributed among different hospitals, as they have different cost structures. For example, if more complex procedures are mostly performed at large hospitals, perhaps large facilities will have to give up some of the less complicated care. This will lead to a variety of shifts, and our hospital will not come out of the reform as it went in.
Speaking of Charité – what are specific ways Charité is addressing the challenges of demographic change, rapid innovation, and digitisation as well as economic pressures?
The two main approaches for Charité are (1) a well-defined overall strategy – we call it Rethinking Health: Charité 2030 and (2) working together with relevant partner institutions and forming strategic networks and alliances.
Our strategy Charité2030 covers all important action areas of university hospitals and puts the “Medicine of the Future” in focus. In fact, our strategy is also relevant for hospital reforms: Demographic change is leading to an ageing society with more demand for healthcare and fewer staff to provide services.
While in the future there will be more outpatient procedures, with many ageing societies we will have many more complex sick people for whom outpatient care might not necessarily be suitable. Thus, we need to find other ways of dealing with this and improve the digitisation of our system.
Additionally, prevention is key. For example, if someone owns a smartwatch with sensors for measuring heart rate, the device can already provide an ECG with a certified diagnosis that you don’t have a cardiac arrhythmia. In the past, I used to need a doctor, a nurse, and an administrator. As this evolves, we’ll have a lot more healthcare at home and we need to connect what’s happening at somebody’s wrists to our hospital and use it for prevention.
What does that mean for patients if university hospitals, that usually focus on the most severly sick people, now focus on prevention?
For us, modern and highly personalised prevention programmes are the goal. This needs to be more than telling people “An apple a day keeps the doctor away” but focus on doing high-tech prevention with a strong focus on the individual. For example, we are currently building a research and prevention centre for cardiovascular diseases at the Charité Benjamin Franklin Campus that is to become the first German university hospital with an explicit focus on prevention.
How does the healthcare system need to adjust to make this work? After all, you don’t get any money for prevention today.
The pressure on patient demand will stay high, but the incentive system is shifting to a retention model. For instance, Singapore assigns a specific group of residents to clinics with an annual budget for their care. This capitation model creates an incentive system and encourages hospitals to focus more on disease prevention. While not directly applicable to Europe or Germany, it’s an interesting approach worth considering for healthcare systems.
Besides focusing more on prevention, how do you envision the role of large university hospitals for national and European healthcare systems in the future?
EUHA hospitals are some of the largest university hospitals in Europe. We are helping to shape the future of the hospital system in many places in an advisory capacity and are trying to provide impetus and act as a role model for the entire system. For instance, Charité’s healthcare professional collective agreement focused on workload relief has served as a model for similar agreements across Germany.
You mentioned that strategic partnerships and networks are part of your strategy to address current challenges for Charité – what role does EUHA play for you and where do you see its unique added value as a stakeholder on the European level?
EUHA is an extremely valuable network that allows us to exchange cross-border information and data in a trusted network of like-minded institutions. For example, during the initial stages of the COVID-19 crisis, interactions with fellow CEOs and CMOs proved invaluable in timely preparations for future waves. EUHA is also helpful in terms of research and exchanging and pooling data in studies.
By doing this together, we can be much stronger and potentially develop new treatment options much faster than by ourselves. Prof Dr Heyo Kroemer
By doing this together, we can be much stronger and potentially develop new treatment options much faster than by ourselves.
EUHA offers us the opportunity to learn from different ways of working in healthcare all over Europe. It allows our staff to work together with excellent partners to drive innovative projects that will benefit all members. Examples of this are the H2O Health Outcomes Observatory project and EUCCAT (European Centre for Gene and Cellular Cancer Therapies), which aims to facilitate the development of academia-developed and affordable ATMPs (Advanced Therapy Medicinal products).
University hospitals are the driving forces for innovation in healthcare. EUHA brings together 10 of the most advanced academic medical centres in Europe and has a great potential for addressing the challenges we are all facing for healthcare in Europe – mainly by educating and training a healthcare workforce fit for the medicine of the future, pooling our resources, maximising our scientific potential, and developing common strategies for health in Europe. Prof Dr Heyo Kroemer
University hospitals are the driving forces for innovation in healthcare. EUHA brings together 10 of the most advanced academic medical centres in Europe and has a great potential for addressing the challenges we are all facing for healthcare in Europe – mainly by educating and training a healthcare workforce fit for the medicine of the future, pooling our resources, maximising our scientific potential, and developing common strategies for health in Europe.
Regarding Europe, how do you see the role of the EU in healthcare?
While healthcare remains the responsibility of the member states, cross-border action in healthcare becomes particularly relevant in emergency situations such as pandemics, war or natural disasters. By pooling our resources and combining our expertise we will be much stronger, than each country by itself.
For example, the European Health Union is an important endeavour for the EU Commission to implement. An example of this is the European Health Data Space framework, as in the future, it will be crucial to quickly exchange health data across borders and use it for research to develop new treatment options. Another example are the European Reference Networks. EUHA is already contributing to both critical endeavours of the European Health Union (e.g., EUHA’s consensus position “EUHA statement: Key aspects for a successful EHDS – University Hospitals are ready to help unlock its potential”).
Another area for the EU to support is the collaborative effort to treat diseases with new ATMPs. These personalised therapeutics are very promising but face regulatory and logistic hurdles, causing Europe to lag behind the US and China in this field. EUHA is committed to this topic and the EU could facilitate the harmonisation of standards and regulations of ATMPs by supporting EUHA (and EUCCAT) and their newly started EUHA-driven project JOIN4ATMP.
Finally, in the direction of rethinking the European healthcare systems, the EU can support the harmonisation of standards for healthcare staff (such as medical degrees, education and training, language requirements, etc.), the standardisation of the regulation for healthcare products, and the promotion of interoperability to facilitate the movement of patients, staff, and medical data across borders. EUHA is already running pilot projects in many of these areas and can be an excellent living lab for the EU to develop these standards and test them.
During the past six months, you have held the presidency of the European University Hospital Alliance and have talked to several European stakeholders. Where do you see the potential of an alliance like EUHA?
As I said earlier, the trust between the EUHA members is extremely valuable for exchanging best practices between the institutions. That said, one of the greatest potentials lies in our combined knowledge and expertise in the various realms of European healthcare systems. As university hospitals, we are at the forefront of biomedical research and innovation, education, research, and policy involvement, and we provide a wide range of healthcare services to patients. We offer comprehensive medical care, including diagnostic services, surgeries, and various specialised treatments, making us very important components of the overall healthcare system in our countries. At the same time, many of us are involved in healthcare policy development at regional, national, and sometimes international levels, with our experts often contributing to shaping healthcare policies and regulations.
EUHA can bring all those experts together and develop a blueprint for the transformation of European healthcare systems. With the support of the European Commission, EUHA could use the existing network of university hospitals to run pilots and test innovative solutions for the healthcare system of the future.
Thank you very much, Heyo! We look forward to continuing working with you on shaping European healthcare.