Diederik Schrijvershof and Annabel Kingma, together with Piet Sippens Groenewegen, have successfully represented more than 200 general practitioners in a dispute with Zilveren Kruis (“ZK”). They are GPs in the province of Friesland who had a contract with De Friesland Zorgverzekeraar until 2021, as well as GPs in the rest of the Netherlands. Since 2022, all these (200+) GPs have had to deal with ZK’s 2022/2023 GP care procurement policy and the associated two-year contract, whereby ZK is changing the reimbursement for (i) the practice nurses and (ii) elderly care. However, ZK’s funding was insufficient to cover the GPs’ costs. Faced with the preliminary relief proceedings instituted by the GPs, ZK decided to adjust the funding in the Netherlands and subsequently also in Friesland, to allow all GPs to choose the funding system that applied to practice nurses and elderly care in Friesland in 2021.
The Netherlands: funding of practice nurses
GP practices have successfully used one or more practice nurses for many years. A practice nurse supports a GP in the field of somatics, among other things. As part of the 2019-2022 Outline Agreement (the “Outline Agreement”), ZK decided to make GP practices more future-proof, to give GPs more time for their patients and to give them more scope to engage a practice nurse. ZK nevertheless changed the practice nurse funding system from the start of 2022 for no reason, which is resulting in financial shortfalls for GPs and is creating a considerable administrative burden for them. ZK's approach was therefore not only contrary to the Outline Agreement, in which it was agreed to reduce the administrative burden and create more time for the patient. ZK's approach also impacted chronically ill patients, among others. As a result of the new ZK funding system, practice nurses caring for chronically ill patients would no longer be reimbursed at cost. All of this put pressure on the engagement of practice nurses, despite the fact that many GPs hired (and had to hire) a practice nurse to keep chronic and other care out of the second line (such as the hospital) and in the first line (GP). The GPs presented a petition to ZK in late 2021, in which they called for continuation of the funding in the years 2019 to 2021. ZK has not yet complied with that petition. Skipr, Trouw and NOS.nl have written about this issue. The NOS news programme also addressed it on 27 December 2021. To avoid preliminary relief proceedings, ZK decided not to make the new funding system for practice nurses compulsory in any event in 2022 and 2023. As from 1 April 2022, ZK will allow GPs to opt for either the current or the previous practice nurse policy. See also here.
Friesland: funding of elderly care
ZK’s new 2022-2023 GP care procurement policy has given rise to financial and organisational problems also in Friesland. Frisian GPs entered into contracts only with health insurer De Friesland Zorgverzekeraar. From 2022 onwards, those Frisian GPs had to enter into a contract with ZK. The funding system for elderly care (as part of the GP care) was changed in a similar way to that of the practice nurses as a result of this switch. This change in the elderly care funding system is furthermore giving rise to financial shortfalls for GPs and is increasing the administrative burden. That was not what the Frisian GPs had expected. The province of Friesland is aging rapidly, also according to ZK. Cuts in care for the elderly were therefore by no means obvious and are foreseeably harmful. Also in this case, ZK decided that in 2022 and 2023 GPs may continue with the customary elderly care policy and the corresponding reimbursement or may opt for the new ZK policy.
Maverick Advocaten assists healthcare providers on a daily basis to achieve cost-covering rates in healthcare or to challenge inadequate turnover and other ceilings. It was previously successful before the Trade and Industry Appeals Tribunal regarding tariff decisions for GP care. Maverick Advocaten has also successfully conducted preliminary relief proceedings on behalf of care providers regarding the procurement of care under the Social Support Act, youth care, forensic care, SGLVG (Serious Behavioural Problems and Mild Intellectual Disability) care and (also on appeal) long-term care. In 2020, Maverick Advocaten successfully represented various acute mental healthcare providers in order to obtain a cost-covering decision from the NZa. In 2021, it successfully conducted proceedings against the NZa before the Trade and Industry Appeals Tribunal on behalf of another acute mental healthcare provider. More recently, Maverick Advocaten represented a healthcare provider faced with a too low turnover ceiling imposed by the healthcare insurer, by requesting the NZa to take enforcement action, among other things. Maverick Advocaten has also been successful in challenging excessive purchasing power of health insurers.
For more information on the rights of healthcare providers in healthcare sales and the ways in which their trade associations can support them can be found at www.zorgcontractering.com.Follow Maverick Advocaten on Twitter and LinkedIn