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Contrary to the assessment of the German Medical Association, the opening clause in the new fee schedule for doctors (GOÄ) is not off the table, according to a recent press release from the Federal Minister of Health. The opening clause of the GOÄ would enable private health insurance companies (PKV) to conclude care contracts directly with individual doctors or groups of doctors.
At GOÄ, a new version is overdue after almost 30 years, not least because the medical-technical progress of the past years has not been taken into account here. The opening clause required by the PKV has so far been one of the main points of controversy in discussions about the new GOÄ. Most recently, the German Medical Association (BÄK) and the Association of Private Health Insurance had apparently agreed on a new fee schedule without an opening clause. The BÄK President Dr. Frank Ulrich Montgomery said on Monday in Berlin that the PKV association should no longer negotiate an opening clause when reforming the official fee schedule. The Federal Minister of Health Daniel Bahr (FDP), however, now contradicts the statements of Montgomery and had a spokesman for the ministry tell the "Ärzte Zeitung" that "the statements by Montgomery that the opening clause is not applicable from the table" are.
The ministry ultimately decides on the contractual competence of the private health insurance company. Apparently the president of the BÄK and the Association of Resident Doctors Germany (NAV Virchow-Bund) were too happy about the supposedly positive result of the negotiations with the private health insurance association. On Tuesday, the NAV federal chairman praised "the progress of the negotiations between the German Medical Association and the Association of Private Health Insurance" and now called for an amendment to the GOÄ, but the current press release from the Federal Ministry of Health now leaves doubts about the supposed agreement between BÄK and PKV association arise. It is noted that the parties involved have agreed on a common business basis and specific quality criteria for a new GOÄ without an opening clause, but the ministry will only decide at the end of the negotiations which contract competencies the PKV will be granted. In advance, the Federal Medical Association and the PKV association must submit an official negotiation result to the ministry, whereby the agreement on the opening clause only plays a downstream role. Rather, the decision of the Federal Ministry of Health on the contractual competencies of the PKV "depends on the basic concept of the outcome of the negotiation," said the spokesman for the ministry.
Association of resident doctors calls for a quick revision of the GOÄ In the opinion of the NAV chairman Dr. Dirk Heinrich is in a hurry to amend the GOÄ hurry, since "finally clear accounting rules in the sense of a functioning consumer protection and for more legal security for the doctors are necessary". "It cannot be the case that modern examination and treatment methods have to be billed on the basis of a completely outdated fee schedule," criticized Heinrich. Since, according to the agreement between private insurers and doctors, "the biggest stones have been cleared", there is nothing standing in the way of a new fee schedule in this legislative period, according to the assessment of the NAV federal chairman in the press release on Tuesday. According to Dr. Heinrich is "the ball in the field of the Federal Ministry of Health" and Minister Bahr must now "make GOÄ reform a top priority." In view of the difficult negotiations, BÄK President Dr. Frank Ulrich Montgomery, however, is rather skeptical about a timely revision of the GOÄ. Before the federal elections in 2013, he expected a maximum of one joint draft, but never a decision by the new GOÄ, according to Montgomery.
Opening clause in the GOÄ has so far always been demanded by the PKV The fact that the PKV apparently voluntarily refrains from further negotiations on the required opening clause seems to be somewhat questionable, as the fundamental importance of this contractual competence for private insurers has always been emphasized. The private health insurance companies hoped that the possibility of direct contract negotiations with the doctors would result in a significant increase in quality while at the same time improving cost control. It was expressly emphasized that the remuneration of doctors should not be pushed below the business basis. Doctors feared this, however, since the negotiating position of individual doctors with private insurers would have been extremely weak. The resistance from the doctors was correspondingly strong. (fp)
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Photo: Michael Dedeke