Floating point value - Floatender Punktwert

The floating point value ( English to float , to float, to fluctuate ) is a term from the professional political lay language. In statutory health insurance, it is understood to be a variable point value that depends on the total amount of services provided by a collective of doctors or psychotherapists.

Fee calculation

The value of every medical or psychotherapeutic service is determined by an assigned number of points (evaluation number). The fee that a contract physician , contract doctor or dentists obtained theoretically calculated by multiplying the evaluation score for a service according to the Uniform Value Scale for medical or psychotherapeutic (EBM) with the point value. However, this fee is not a guaranteed fee, but depends on the fee volume from the health fund available to the health insurance companiesfrom. As a rule, this fee volume must not be exceeded, as the primacy of stable contribution rates in accordance with Section 71 of Book V of the Social Code applies , particularly in the medical and psychotherapeutic field . As a control instrument against the threat of exceeding the available fee volume, the associations of statutory health insurance physicians issue a country-specific fee distribution standard in consultation with the health insurance companies . [1]

Total remuneration cap

If the total upper remuneration limit were to be exceeded in the event of a payment of the agreed point value due to an increase in the total amount of services provided by a collective of doctors or psychotherapists, then the point value is reduced proportionally to the increase in amount. Since the amount of work is only determined after the final bill for a year, the final point value can only be calculated afterwards, usually in the middle of the following year. Until then, the doctor or psychotherapist will receive estimated payments on account from his association of statutory health insurance physicians and, while the service is being provided, he will not know what fee he will actually receive for the services provided. [2]

criticism

The primacy of the contribution rate stability, which led to the "floating point value", does not take into account, on the one hand, a possibly increased need for treatment of the insured and, on the other hand, no increase in the number of doctors or psychotherapists. One negative effect is that the floating point value leads to a “hamster wheel effect” in the sense of a metaphor: It causes an increase in the amount of work, because every doctor or psychotherapist concerned tries to compensate for the cuts by providing more and more services, which leads to a further increase in the amount of work which leads to a further decrease in the point value. [2]

Individual evidence

  1. ^ Rudolf Ratzel, Bernd Luxenburger: Handbuch Medizinrecht . Deutscher Anwaltverlag, 2008, ISBN 978-3-8240-0778-3 , p. 370–.
  2. ^ A b Constanze Janda : Medical Law . UTB, October 4, 2012, ISBN 978-3-8252-3736-3 , pp. 200-.