GOÄ-Reform Bahr contradicts Montgomery

Minister of Health contradicts the BÄK president

05/17/2012

Contrary to the assessment of the German Medical Association is according to a recent press release by the Federal Minister of Health, the opening clause in the new fee schedule for doctors (GOÄ) not off the table. The opening clause of the GOÄ would allow the private health insurance companies (PKV) to conclude supply contracts directly with individual doctors or doctor groups.

At the GOÄ a new version is overdue after nearly 30 years, not least because the medical-technical progress of the past years is not considered here. The opening clause required by the PKV was one of the main points of controversy in the discussions on the new GOÄ. Recently, however, the German Medical Association (BÄK) and the Association of Private Health Insurance had apparently agreed on a new fee scale without opening clause. The BÄK president dr. Frank Ulrich Montgomery said on Monday in Berlin, that even on the part of the PKV-Verband in the reform of the Official Fee Regulations should no longer be negotiated on an opening clause. However, the Federal Minister of Health Daniel Bahr (FDP) now contradicts the statements of Montgomery and let through a spokesman for the ministry to the „Doctors newspaper“ notify that „Montgomery's statements that the opening clause was incorrect from the table“ is.

At the end, the ministry decides on the contractual competence of private health insurance
Apparently, the president of the BÄK and also the Association of doctors in Germany (NAV Virchow-Bund) on the supposedly positive outcome of the negotiations with the PKV Association were too early. The NAV national chairman praised on Tuesday „the progress of negotiations between the German Medical Association and the Association of Private Health Insurance“ and now urgently needed to implement a revision of the GOÄ, so the current press release of the Federal Ministry of Health now, however, raises doubts about the alleged agreement between BÄK and PKV Association. It is noted that the parties agreed on a common business basis and specific quality criteria for a new GOÄ without opening clause, but the ministry decided only at the end of the negotiations on which contract competencies of PKV are granted. In advance, the German Medical Association and the private health insurance association must submit an official negotiated result to the Ministry, whereby the agreement on the opening clause plays only a secondary role. Rather, the decision of the Federal Ministry of Health depends on the contract competencies of private health insurance „from the basic concept of the result of the negotiation“, said the spokesman for the ministry.

Association of established physicians calls for rapid revision of the GOÄ
According to NAV Chairman Dr. Dirk Heinrich is advised in the amendment of the GOÄ hurry, since „finally clear billing rules in the sense of a functioning consumer protection and for more legal certainty for the doctors“ are required. „It can not be that modern examination and treatment methods have to be accounted for on the basis of a completely outdated fee schedule“, Heinrich criticized. Because after the agreement of private insurers and doctors „the biggest stones have been removed“ are, stand „a new fee regulation in this legislative period, nothing more in the way“, so the assessment of the NAV federal chairman in the press release of Tuesday. According to Dr. Heinrich is lying „the ball in the field of the Federal Ministry of Health“ and Minister Bahr must now „make the GOÄ reform a top priority.“ In view of the difficult negotiations, the BÄK President Frank Ulrich Montgomery, however, is rather skeptical of a timely rewording of the GOÄ. He expected before the federal elections 2013 maximum with a joint draft, but in no case with a decision of the new GOÄ, the statement of Montgomery.

Opening clause in the GOÄ of the PKV so far always required
The fact that the private health insurance seems to voluntarily renounce further negotiations on the required opening clause, seems slightly questionable, since so far always emphasized the elementary importance of this contracting authority for private insurers. The private health insurance companies hoped that the possibility of direct contract negotiations with the physicians would significantly increase quality while at the same time improving cost control. It was expressly emphasized that the remuneration of the doctors should not be pushed under the business management basis. However, the physicians feared this precisely because the negotiating position of individual physicians towards private insurers would have been extremely weak. Strong resistance was on the part of the doctors. (Fp)

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Photo: Michael Dedeke