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Berlin In the past week there has been criticism from some professional associations about the draft of a new fee schedule for doctors (GO). The President of the Federal Medical Association, Klaus Reinhardt, explains in an interview with German medical journalhow the draft was developed and what options the medical profession now has.

Why are the medical profession pushing so hard for a new GO?

The GO is much more than a fee schedule according to which private treatments are billed. The fee structure is an essential feature of our freelance profession. It is essential for the distinction between freelance work and business. It is also important: Without the GO benchmark, it would be politically much easier to reduce the level of performance in the statutory health insurance sector.

The more the GO becomes outdated and thus loses internal legitimacy, the less it can fulfill its structural role for the medical profession and patient care. This then plays into the hands of those who want a different system, be it a standard fee structure or citizens’ insurance. That’s why we have to resolve the political blockages on the way to a new GO.

Why is there a need for an agreement between the Federal Medical Association (BK) and private health insurance (PKV)?

The medical profession has been fighting for a new GO for decades. We are confronted with a cross-party issue: politicians are making an agreement between the medical profession and private health insurance a prerequisite for an amendment. This is basically alien to the system, because the GO is a state regulation. Nevertheless, this juncture is a political reality. And the truth is that such a junction was also discussed by the medical profession in earlier years.

There have now been repeated calls for a doctor’s own proposal to be made to politicians without the private health insurance and subsidies.

This is exactly the path we took. At the beginning of 2023, I personally handed over our entire doctor’s own GO to the Federal Minister of Health. Since then, we have put intensive pressure on the minister and other political leaders. Nevertheless, it remains the case that politicians do not want to tackle the amendment as long as the BK and PKV do not come to an agreement. This applies expressly across party lines. That’s why we’ve now explored with PKV where a compromise line can lie. Aid has also been included. The medical profession must now form an opinion on this.

Others criticize that the process is not transparent enough.

The list of services and the doctors’ own assessments with which we entered into discussions with the PKV were developed together with 165 medical associations. On this basis, we held intensive, months-long discussions with the PKV. It is obvious that 165 associations cannot be involved in such discussions. That would not have been compatible with a realistic timetable or with the nature of such discussions. We now have a result that we see as an offer for an agreement. We have discussed the framework of this draft twice in detail with the medical associations. We then sent the draft to the associations. A decision will only be made once feedback from the associations has been received. Several associations had previously suggested a period of 14 days for the review. However, some associations now need more time. We will take this time and come together again for an association discussion. A publication of the draft is planned once the changes resulting from the feedback from the associations have been incorporated. In my opinion, this is an orderly and very transparent process.

If the new GO came into force as it was sent to the associations, what would be the outcome for the medical profession?

To put this into perspective, you have to know that in 2017 the medical profession had already agreed to a price effect of around 6% for the first three years after the introduction of a new GO. Since then, private health insurance expenditure on medical treatment has continued to rise despite unchanged GO, significantly exceeding what would be expected due to aging and morbidity. Nevertheless, we have now managed to expand and open up the framework agreed in 2017. The PKV now accepts a higher price effect and both sides assume an increase in the total volume of PKV spending of 13.2%, which is around 1.9 billion euros. Mind you: This is not a budget, but a forecast.

Equally important is that we were able to fend off all attempts to change the fundamentally new character of the GO we developed: a GO characterized by billing exclusions and an outdated and limited fee schedule is now becoming a GO with a highly differentiated, medically developed fee schedule. Billing exclusions will be avoided to an extent that will require a great deal of responsibility when applying the new GO.

At the event for the associations, the mood was largely positive. Were you surprised by the sometimes clear criticism of individual associations afterwards?

We have always made it clear that the discussions with the association could only be about a non-binding picture of the mood with a view to the basic framework conditions. Since September 12th, the associations have been evaluating the draft based on the written documents. In addition to the basics, we also take a look at the individual evaluations. Since then we have received a mixed response: There is criticism, some of which is expressed very loudly and publicly. But there is also usually less loudly expressed approval from other associations that also represent large parts of the medical profession. It is not surprising that such an important project is controversial within our diverse profession. My wish is that we weigh up the pros and cons fairly and objectively within the medical field.

A main point of criticism relates to the devaluation of technical achievements in return for the appreciation of speaking medicine.

Increasing the value of medical attention during discussions and examinations was always one of the main goals for a new GO. It’s good that the PKV is now ready to address this. This doesn’t just benefit speaking subjects. It benefits all doctors who talk to and examine their patients. Finally, the medical coordination services in the GO should also be reimbursed independently.

In the discussions with the PKV, we also argued very emphatically for the assessments in all other areas of the GO. But it shouldn’t surprise anyone that a compromise had to be reached in the end. The PKV is of course keeping an eye on the impact on its already increasing insured contributions. That’s why she initially didn’t want any additional costs from a new GO. She has demanded extensive devaluations and billing exclusions compared to the doctor’s own version. It also had to be clear to everyone involved that the PKV would question the time information on which the doctor’s own assessments were based.

However, in the impact assessment we made sure that appropriate remuneration was provided in all areas, including the so-called technical subjects. Some associations fear devaluations that go beyond this. With these associations we will analyze the effects again in peace. With 5,500 fee items, you can never rule out the possibility that there are still problems somewhere. We discussed with the PKV that factually well-founded corrections are possible as long as they do not question the overall framework.

Others criticize the changes in the paragraphs of the GO, especially the removal of the increase

We debated this extensively in the medical profession years ago and finally, at the 120th German Doctors’ Day in 2017 in Freiburg, under the precondition of regulatory stability, we agreed with an overwhelming majority to the framework conditions on which we have now based the discussions with the PKV. I can only advise against starting this debate all over again. When it comes to the controversial rise, we know that large parts of the medical profession hardly make use of it. The increase is now being replaced by a large number of specifically named surcharges, with which increased costs can be asserted in a legally secure manner. I still think this is a good solution. And to prevent misunderstandings: the possibility of analogous assessments and different fee agreements remains.

What options does the medical profession have now? Some are calling for negotiations to be restarted.

The negotiations with the PKV have been conducted for more than ten years with different negotiating teams and strategies. Now for the first time there is the option for a compromise. We have agreed with the PKV that we can of course still make factually justified corrections within the agreed framework.

Beyond this, however, the PKV has clearly signaled that there can be no further room for negotiation. And I’m not the only one who has considerable doubts about whether it would be possible to restart discussions with the PKV.

The political juncture is in place. However, with an agreement we would now have the opportunity to finally bring movement back into the political process for a GO amendment.

Recently, there has been a growing cross-party realization that there is a need for action after decades of standstill. Politicians cannot easily ignore a joint proposal from the BK and PKV. This is all the more true since the aid was also included. And all factual arguments are on our side anyway.

However, such a proposal must be able to be supported by the broad spectrum of the medical profession. This is the question we are now faced with. Nothing has been decided. We are facing an important decision, in the end it is always a question of yes or no. I advise you to weigh things up carefully. © mis/aerzteblatt.de