In 2010 a total of 9 guidelines on structural quality were endorsed by the Association of Rheumatology Clinics in Germany (VRA). These 9 structural criteria replace the regulations published in 2002 and were elaborated with the support of the German Rheumatology League. With guideline number 9 even the structural requirements for university hospitals are defined for the first time.Along with taking part in the quality project "Kobra" (continuous outcome benchmarking in rheumatology inpatient treatment) compliance with the new structural criteria constitutes a prerequisite for acquiring a quality certificate, which is awarded by an external institution.By this means the VRA sets the stage for its members to be prepared for future challenges and quality competition among hospitals. Furthermore, the provision of a high quality treatment for chronically diseased patients in rheumatology clinics will be effectively supported.

Due to the general lack of physicians in German hospitals new approaches are necessary to be successful in acquiring doctors for training in inpatient rheumatology.Although the financing of rheumatology education is still included in the general payment of hospitals, currently the diagnoses-related groups,,as it has already been fixed in the regulation on hospital care rates in Germany since 1994, new strategies may help to improve the financial situation of hospital units.The implementation of a binding structural quality, endorsed by the Association of Rheumatology Clinics in Germany (VRA), as well as the application of clinical pathways will optimize revenues.Further financial improvements can result from the implementation of case management, the implementation of interdisciplinary treatment, the promotion of a high quality treatment, from a differentiated approach towards outpatient treatment and a specialization within inpatient rheumatology units.Incorporating these strategies the advantages may not only affect the financial situation of hospitals but may also offer valuable incentives for physicians to start their professional career in inpatient rheumatology.

In the current draft of the law on the reform of the support structures of hospital provision (German Hospital Structure Law) the future quality of provision is highly significant. Quality assurance measures are mandatory for hospitals. The Federal General Committee was legally charged with developing the relevant quality indicators for structural, procedural and outcome quality that are designed to form the criteria and the basis for planning decisions in the federal states. This involves a paradigm shift in quality assurance measures in hospitals. In the future, subject to the verified quality, this should have an influence on hospital planning, and the funding or regulation of hospital departments should also adhere to this prescribed quality. This review reveals the course of quality or quality assurance measures in medical services in Germany. The status of the institutions responsible for the quality of care in hospitals and the significance of quality indicators are explained.

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