At the 63rd Annual Meeting of the Society for Thrombosis and Hemostasis Research (In German: Gesellschaft für Thrombose- und Hämostaseforschung e.V. or GTH) in Berlin, the professional symposium of the Professional Association of German Hemostaseologists (In German: Berufsverband der Deutschen Hämostaseologen e.V., or BDDH) took place once again in 2019. The public part of the meeting was titled: "A one-year treatment contract". Speakers from the BDDH, the vdek, the AOK and a practicing physician presented their views on the topic.
The one-year treatment contract: quite clearly a success, say the parties involved. Dr.med Jürgen Koczielny of the Charité University Hospital in Berlin and member of the board of the BDDH played a major role in drafting this contract. and at the beginning of the symposium, he once again explained what he considered to be important points for patients, the medical profession and health insurance companies. An important impetus that led to negotiations with the health insurance funds was the remuneration gap that arises from services to be provided, which are neither reflected in Uniform Evaluation Standards (In German: Einheitlichen Bewertungsmaßstab or EBM) nor Fee Schedule for Physicians (In German: Gebührenordnung für Ärzte or GÖA). Koczielny puts the gap at between 1,200 and 1,500 euros per quarter for infant patients.
The now existing, non-governmental treatment contract with the Association of Substitute Health Insurance Funds (In German: Verband der Ersatzkassen e.V. or vdek), which is adaptable and should continue to be adaptable in the wake of forthcoming legislative changes, offers at least the solution to this problem of fair distribution. With this contract, the medical profession benefits from a simple and cost-free billing method and receives fair quarterly lump sums for the provision of factor preparations to its patients insured under the health insurance scheme. Here, the diagnoses that were actually relevant to everyday life were taken into account and mapped, which Koczielny describes as a milestone for the practice. Another relief is the elimination of price negotiations with the manufacturers of the preparations. Not only were agreements reached on financial flows, but case management was also established. The health insurance companies involved now provide concrete contact persons who take care of the patients' problems.
Maurice El Talia from vdek was able to confirm the positive mood. A survey had shown that the treatment contract with an acceptance of more than 80 percent is rated very positively by the centers and practices with treatment contracts and is perceived as enriching in many aspects.
The perspective of AOK Nordost, on the other hand, was more critical, as no successful negotiations have yet been conducted in favor of a contractual agreement and standardization. Bettina Piep, a pharmacist at the AOK Nordost, first stressed the structural difficulties that arise from the fact that each AOK is organized for itself and this makes it more difficult to implement nationwide contracts. However, it emphasizes that, in view of the supply situation, it would also make sense for AOK Nordost to conclude a corresponding contract.
Piep sees a need to conclude contracts with specialized centers, taking into account both the number of cases and other criteria when determining which institutions can be specialized centers. Furthermore, a hemophilia nurse was to be included in the care, the costs of which would be shared by the AOK Northeast, as well as private practices. Transparent discount agreements with manufacturers and uniform procurement channels as well as better management of hemophilia patients - for example when moving house - are further points in the list of requirements of AOK Nordost. In principle, Piep emphasized the willingness for further negotiations.
From the user's perspective, Dr. Wolfgang Mondorf from Frankfurt reported enthusiastically about the changes that the treatment contract brings with it for the practice and also emphasizes the fruitful and goal-oriented cooperation of all involved right from the start.
The major advantages of the contract for Mondorf after one year are the smooth ordering process for concentrates, the fixed assignment of contact persons on all sides, no electronic prescription processing, optimum data security, economic security for the centers and rapid adaptation to new concentrates.
Summarizing for all speakers of the BDDH symposium Mondorf emphasized at the end of his presentation once again the necessity of concerted and concentrated cooperation of all, in order to be able to include also the upcoming law changes and possibly arising difficulties as purposefully and profitably as possible for all parties in the treatment contract.