Outpatient medicine | Is the supply of laboratory diagnostics at risk?

Since January 1, a new so-called Uniform Assessment Standard (EBM) has been binding for billing for statutory health insurance services. This is the statutory health insurance fee schedule for physicians and psychotherapists. The current design has drawn criticism from, among others, laboratory physicians, which they voiced at a press conference in Berlin on Thursday.

Physicians (who often also own larger laboratory operations) now have access to the first-quarter billing data. This confirms what the Association of Accredited Laboratories in Medicine (Alm), among others, had already suspected, or rather, simulated in advance: The reform will result in financial losses for them. According to Alm Chairman Michael Müller, the statutory health insurance-based medical facilities are coming under massive economic pressure.

Furthermore, the blanket cuts to hundreds of laboratory services are not economically sound. As a result, both the accessibility and availability of services are changing. Courier drivers are unable to come even less frequently due to non-fully reimbursed costs. For economic reasons, small laboratories, among others, are already outsourcing services to other facilities. Müller cites an example of the deteriorating care: "A screening test for acute HIV infection is no longer cost-effective for anyone in Germany. Who will then provide these tests?" Laboratory mergers or the disappearance of small laboratories are foreseeable.

However, if the current hospital reform is to progress, more outpatient services will be provided, Müller argues, comprehensive, community-based care must be maintained. Even smaller hospitals or follow-up facilities straddling the border between outpatient and inpatient care require reliable laboratory diagnostics.

Ralf Ignatius explains the potential impact of such a thinning of supply. The microbiology specialist fears delayed diagnoses and a "gradual deterioration in test quality." PCR tests have gained importance during the coronavirus pandemic. They can avoid unnecessary antibiotic treatment, especially in children with (severe) respiratory illnesses. According to Ignatius, one in three children with a cough and fever now receives a diagnosis based on this test. This means that parents no longer have to visit emergency rooms or seasonally overcrowded doctors' offices. "Antibiotic prescriptions have declined for good reasons," says Ignatius, who represents the professional association of physicians specializing in microbiology, virology, and infectious disease epidemiology.

Now, however, laboratory physicians face additional adversity in the form of a new German Medical Fee Schedule (GOÄ). This will regulate the fees paid to practicing physicians from private health insurance companies. This reform is long overdue. Even though it only affects the care of about 10 percent of the population—namely, those with private insurance, those entitled to benefits (civil servants), and those paying for their own services—this income is vital to the survival of many physicians. The significantly improved billing options will enable them to generate profits for their practices, or even simply stay in the black. The new GOÄ is scheduled to be adopted at the end of May at the German Medical Congress in Leipzig. From the perspective of laboratory physicians, it urgently needs to be revised.

This reform would also further increase the pressure on medical laboratories. The entire healthcare system is at risk: "Around 70 percent of all diagnoses are based on laboratory diagnostic results," says Alm representative Jan Kramer. "Without modern laboratory medicine, there can be no reliable diagnostics, no well-founded treatment decisions, no effective follow-up, and no early detection." However, the new GOÄ (Fee Scale for Medical Fees) undervalues ​​medical services, ignores innovations, and compensates medical activities unequally. If no action is taken, laboratory physicians in Leipzig could also refuse to consent to the new fee schedule.

If the revised GOÄ draft is accepted as a compromise between the medical profession and the Association of Private Health Insurers, it can be submitted to the Federal Ministry of Health. The federal government would then issue a corresponding legal regulation with the approval of the Bundesrat.