Eye examination in an MVZ of the Arbeiterwohlfahrt in Magdeburg
Photo: ZB/Jens Wolf
Medical supply centers (MVZ) have existed in various ownership variants since 2004. The National Association of Statutory Health Insurance Physicians has given 3,850 such facilities by 2022. In recent years, the media have repeatedly pointed out that investor-managed MVZs in particular put their business goals ahead of adequate medical care for patients. According to research by the ARD political magazine »Panorama« in spring 2022, more than 500 ophthalmological practices in Germany now belong to international financial companies. It is estimated that around a fifth of all outpatient ophthalmologists now work in chains owned by investors.
Also about a year ago, the Bavarian Association of Statutory Health Insurance Physicians had commissioned an expert opinion that came to the conclusion that MVZ billed “higher fee volumes”. However, this was rejected by the Federal Association of Medical Care Centers.
In addition to such accusations, there is a lack of data on the prescription and referral behavior of MVZs. Just like the perspective in which MVZ now actually which investors call the shots. There are many complaints about this, from research and professional medical representatives. The federal government also acknowledges the deficiency.
Demographic developments, the rapidly growing shortage of staff in health professions and the upcoming hospital reform with its effects on outpatient care mean that there is a new need for regulation in terms of MVZ. Actually, as the operators of the centers see it, their facilities are exactly what is needed now.
The advantages were discussed at an event of the Federal Association of Operators of Medical Care Centers (BBMV) on Wednesday in Berlin. According to this, the supply gaps are likely to grow, and younger doctors are less and less interested in settling down, but instead want to work with less stress. This is exactly what they could do in an MVZ: More time for the patients, bureaucratic parts of the work done by other professions. This is how the operators advertise, also based on their own surveys.
One reason for the BBMV event was the presentation of a new legal opinion. In it, the Munich constitutional lawyer Martin Burgi shows the legal framework for future regulation, based on existing ideas from the German Medical Association and the health ministers of the federal states. Most recently, Bavaria, Rhineland-Palatinate and Schleswig-Holstein submitted an application for an MVZ regulation law to the Bundesrat. According to the expert opinion, a number of the proposed measures would be untenable under constitutional and European law, including a ban on MVZs without a local and professional connection to a clinic. It would be possible to prohibit participation in contract medical care if the medical decision-making freedom is restricted. There is also no objection to stricter transparency requirements.
In the GDR there were polyclinics as state institutions in which physicians of various specialties and other health professionals were employed. The model appeared to the resident physicians of the Federal Republic (rather to their professional politicians) to be such dangerous competition that they knew how to prevent it from continuing to exist. Franz Knieps, today the board member of the BKK umbrella organization, who once also Brandenburg Minister of Social Affairs Regine Hildebrandt had advised. While back then, at the beginning of the 1990s, there were still warnings about too much state medicine, there are currently warnings about the “economy” of medicine. The impression is created that the current vehemence in the fight for an MVZ regulation is further driven by ideology – in the interest of the established medical lone fighters.
When medical care centers were made possible in 2004, the owners initially had doctors in mind, but also other healthcare professionals. In the meantime, hospitals, certain providers of dialysis services and some non-profit organizations have also been approved for founding. This was not thought through to the end insofar as investors also bought companies entitled to be founded.
Michael Weller, head of department in the Federal Ministry of Health, explained at the Berlin event that future legislation would “of course” work towards the goal of guaranteeing high-quality and needs-based medical care. Nobody is taken “off the net”. As of now, the proportion of investor-managed MVZs is far from dominating the market.