“The principle of additional contributions and surcharges is being upheld”
German legislation on improving the provision of therapeutic and medical aids (HHVG)
From Bauerfeind Life Magazin
Dr. Roy Kühne, a graduate in sports therapy and a physiotherapist , played a leading role in formulating the HHVG. As a member of the German parliament , the CDU politician is involved in areas of the government like the Health Committee, where he reports on therapeutic and medical aids and is responsible for healthcare professionals other than physicians.
Bauerfeind life: Dr. Kühne, how satisfied are you with the HHVG?
Dr. Kühne: We set clear standards for all stakeholders in the medical aids industry, focusing on patient wellbeing and ensuring that manufacturers can continue to operate in a freely competitive environment. We continued to work on important points and wrangled with lots of contentious issues right to the very end. I am pleased that the law was passed in its agreed form and I am very satisfied with the result.
One of the law’s main aims is to introduce measures to improve service quality. Could you name some examples?
Dr. Kühne: We are sticking to a system of tenders for standardized aids but have also established strict quality standards. The specifications or award criteria must be defined in such a way that quality-related aspects are taken sufficiently into account; if these product or service quality requirements are not already laid down in the specification, the weighting of the award criteria concerning prices and costs must not exceed 50 percent. The quality criteria to be taken into account comprise both product and service quality. The availability of the customer service line or the proximity and accessibility of the service provider can now also be included as crucial selection criteria.
The provision of higher quality products paid for in part by patient contributions is a major issue for service providers in the field of medical aids. What does the HHVG permit in this regard?
Dr. Kühne: The principle of additional contributions and surcharges is being upheld. It is imperative that patients still have access to high-quality aids without needing to pay any surcharges. Insured patients are not in a position to contribute to special , customized products to the extent some people would like them to be. A high-quality mid-range product which quickly and effectively achieves the desired results must still be reimbursed. The patient’s income must not be the determining factor here, as everyone is entitled to access to high-quality aids. However, anyone looking for a top-of-the-range medical aid must pay a contribution.
Greater priority is now given to quality criteria during tender processes. What does that mean for service providers?
Dr. Kühne: Service providers must advise insured parties on which aids and additional benefits are suitable and medically necessary for them. The advice given must be recorded in writing and confirmed by the insured party. When billing the health insurance companies, service providers are obliged to state the additional costs agreed with the insured parties. Health insurance companies are now required to monitor agreements on the provision of medical aids by performing random checks and looking out for any abnormalities. This will enable them to verify whether service providers are complying with legal and contractual obligations. In return, service providers must provide insurance companies with the information required in order for these checks to be carried out.
The extensive revision of the German Medical Aids Directory and the periodic updating of the product groups it contains proved a contentious issue during the run-up to the passing of the new legislation. To what extent has the HHVG made a breakthrough here?
Dr. Kühne: The German National Association of Statutory Health Insurance Funds (GKV-SV) must step up to the mark in precisely these two areas. By December 31, 2017, it must adopt rules of procedure governing the process of adding aids to the Medical Aids Directory and of updating the directory. By December 31, 2018, all product groups in the Medical Aids Directory that have not been thoroughly updated since June 30, 2015 must have been systematically reviewed and updated.+
Do you not worry that , in order to avoid being subjected to random checks, service providers will prefer to offer less expensive products, causing the quality of service to suffer as a result?
Dr. Kühne: No, that doesn’t concern me. Service providers do their job and carry out their duties responsibly to the best of their ability. They provide comprehensive information to their customers, answer their questions, and try to do the best by their patients. Many service providers have been successfully following this strategy for years, if not decades, and I expect the situation to be able to remain this way.
In the weeks leading up to the adoption of the resolution, Section 302 Paragraph 5 of the German Social Security Code (SGB V), which relates to this issue, was discussed at length. Like many of my colleagues, I have been strictly opposed to any policy that puts service providers under suspicion. The Federal Ministry of Health stated that it wished to receive more information about surcharges so that it could identify any irregularities. In the end, we came to a compromise and it was decided that the number of additional payment agreements concluded and the average amount of resulting surcharges would be reported without reference to the insured parties and facilities concerned. We are giving the GKV-SV the task of collecting this information so that we can identify any black sheep that may damage the reputation of the entire industry.
Picture: Spieker & Woschek Fotografie