Fee negotiations: Doctors and health insurance companies set the first stakes
Berlin. It was a deliberate pinprick: "zero round." With this inflammatory phrase, the head of the Techniker Krankenkasse (TK), Dr. Jens Baas, set the tone for provocation shortly before the start of negotiations on the fees of contracted physicians and psychotherapists.
Baas, a doctor of medicine, has been in the business for a long time . He knows the kind of ripple effect a comment like the "zero round" creates among the medical profession. The reaction was—as expected—prompt. However, it wasn't foaming at the mouth and was essentially matter-of-fact.
Compensation adjustments “urgently needed”The general consensus: What the TK CEO is demanding is completely unacceptable. Given the increased personnel costs of practices, "compensation adjustments" are necessary in 2026, explained the board members of the National Association of Statutory Health Insurance Physicians (KBV).
Shortly before the first hearing next Tuesday (August 19), the first demands are on the table: In a joint press release, the General Practitioners' Association (HÄV) and the Professional Association of Paediatricians and Adolescent Doctors (BVKJ) have laid down their groundwork.
The reference value (OW) must be increased by "at least" seven percent, according to a joint press release. The Virchow Association had previously stated that its proposal for an adjustment in remuneration would also be at least seven percent.
Heinrich: Practices are not the cost driver“Anyone who wants to continue to have practicing physicians in 2040 must provide sustainable financing for their practices,” says Federal Chairman Dr. Dirk Heinrich, explaining his expectations.
The “zero round” for fees has been part of the threat scenario in which the negotiations between contracted doctors and psychotherapists as well as health insurance companies take place, and not just since the initiative of TK CEO Baas.
In recent years, the freeze has somehow always been on the table. In 2023, the GKV-Spitzenverband (National Association of Statutory Health Insurance Funds) brought the inflammatory phrase into play before the negotiations. Ultimately, the KBV and the health insurance funds agreed on a 3.85 percent increase in the reference point value in the Extended Assessment Committee (EBA). The EBA is created when the impartial member must be consulted. Currently, this is health economist Professor Jürgen Wasem.
In 2024, the negotiations also ended with a 3.85 percent surcharge on the point value, which thus rose to 12.3934 cents. The health insurance funds had offered 1.6 percent, while the KBV demanded significantly more. This agreement was also reached in the EBA. Some members of the medical profession called the result a "de facto zero increase": the fee increase was insufficient to offset cost increases.
If the surcharge at this level is not applied, care will be "significantly worse," warns the ENT doctor from Hamburg. Furthermore, all penny pinchers should take note that the approximately 100,000 general practitioners and specialists' practices are not the driving force behind healthcare costs.
"On the contrary: For a fraction of the resources flowing into the inpatient sector, general practitioners shoulder 578 million treatment cases and more than a billion doctor-patient contacts per year." Inpatient care accounts for only 17.2 million cases. "Cutting costs on outpatient care would therefore be the wrong approach."
Are the appeals and suggestions bearing fruit?It remains to be seen whether such appeals will bear fruit with the KBV’s negotiating partner – the GKV-Spitzenverband (National Association of Statutory Health Insurance Physicians) and its deputy head, Stefanie Stoff-Ahnis, who is responsible for fee negotiations.
When asked about the health insurance side's expectations for the negotiations, a spokesperson responded cautiously, as expected, saying they do not comment on ongoing negotiations.
There are, however, indications: In the current round, the GKV-Spitzenverband (National Association of Statutory Health Insurance Funds) has not yet submitted a concrete offer. However, there has been no mention of a "zero round" from the association either.
Praise from FALKThis has drawn praise from the Free Alliance of State Physician Associations (FALK). "As FALK, we advocate for active and effective self-government. Therefore, we expect the contracting parties to reach an agreement without political interference," their representative in the capital, Martin Degenhardt, told Ärzte Zeitung.
Degenhardt said it was a good thing that the GKV Association refrained from a freeze this year. The main focus now is to offset increased costs for practices in the benchmark value negotiations. There's a lot to be done in this area.
Negotiations? That sounds like an exchange of arguments and a constructive reconciliation of originally divergent positions. Doctors increasingly experience the disputes over fee developments as a mere ritual .
Real negotiations or ritual?The spokesperson for the Hartmannbund doctors' association, Michael Rauscher, put it this way in an interview with the Ärzte Zeitung: The formal requirements for "pricing" hardly allow for "real negotiations based on truly relevant principles," as we have had to experience "painfully" for years.
The question also arises as to whether it makes sense to publicly enter the race with concrete figures – even though the demanded surcharge of seven percent for the OW is “entirely appropriate”.
According to Rauscher, the fact is that practices face challenges beyond inflation: digitalization, care management, etc. It is positive that salary increases for medical assistants (MFAs) should be automatically included in the calculations. (af/hom)
Arzte zeitung
