/dpa
Berlin – Under what circumstances are contracted emergency room doctors considered self-employed? This question has recently led to restrictions on provision in some federal states. Now, politicians and the medical profession have apparently agreed on three criteria.
The Federal Ministry of Health (BMG) and the Federal Ministry of Labor (BMAS) together with the National Association of Statutory Health Insurance Physicians (KBV) and the statutory health insurance associations (KVen) have drawn up the requirements for the future design of the statutory emergency medical service.
In a corresponding article, the German medical journal is available, it is stated that these points should also allow in the future to organize the contracted medical emergency service with the involvement of pool doctors working independently.
The Federal Social Court (BSG) ruled in 2023 that the pool doctor employed by the dental emergency service is not automatically self-employed, but that the specific circumstances of the individual case are decisive.
The points developed by BMG, BMAS, KBV and KVen
- As with treating insured individuals in their own practice, physicians bill themselves for the specific services they provide according to the fee schedule with their own billing number and are paid according to the services they actually provide.
- Physicians pay a user fee that is appropriate in relation to actual operating, personnel and material costs and is not related to sales for the use of the facilities provided by the KV for the contractual emergency medical service as well as for personnel and material resources. The user fee must also be paid if no or only a few insured persons were treated.
- The physician is not obliged to personally provide the contracted emergency service, but may be represented by a duly qualified person of his choice. For the purposes of patient safety and quality assurance, the KV has the right to establish a minimum standard for the qualifications of such a representative.
In the case of dependent employment, however, the social security obligation applies – which is why several KV have restricted or even stopped the use of pool doctors, citing the unmanageable financial burden.
According to the newspaper, an intensive dialogue process on this issue has been taking place since summer 2023 between the BMAS, BMG, KBV, some KVs and medical associations – including technical discussions at the level of state secretaries.
The aim of the discussions was “to examine the topic comprehensively, create a common understanding and derive from it conceivable options for action.”
Taking into account the fact that the BSG stressed in its decision that the assessment of the status under social security legislation only affects the specific facts at issue and in this regard a differently designed contracted emergency medical service could also lead to a different status for the assignment of the activity under the emergency medical service contract. A possible regulatory framework was jointly developed (information box).
This applies, among other things, to the invoicing of services provided, the payment of fees for the use of facilities, for example, and representation regulations.
If these requirements are met cumulatively, then, in the opinion of those involved in the article, both contract doctors and contract doctors of the contracted medical emergency service can be considered independent workers.
The German Pension Insurance Federation, which is also involved in the dialogue process, wants to ask the institutions involved in the joint collection of contributions to agree on this administrative interpretation and then inform the KBV.
According to the newspaper, the BMG and the BMAS also intend to initiate legal action. For example, it should be made clear that the KV can make more detailed provisions to ensure the provision of mandatory emergency medical services, including the granting of fixed security payments, insofar as these are necessary to ensure this.
There should also be a legal clarification that the work of doctors hired in the contracted medical emergency service must be assessed as independent as an annex to the contracted medical activity, even without fulfilling the above-mentioned requirements. © aha/aerzteblatt.de