Degression (contract dentist)
Contract dentists were the only group of doctors in the German healthcare system to be subject to degression . Degression means that the dental fee is gradually reduced from a certain number of dental services. The basis for this was § 85 para. 4b-f SGB V .
Due to the Date Service and Supply Act (TSVG) passed on March 14, 2019, paragraphs 4b to 4f of Section 85 SGB V were deleted with effect from May 11, 2019, whereby the degression regulation is no longer applicable.
Each dental service is assessed with a certain number of points in the assessment standard for dental services (BEMA). From a total number of points per contract dentist of 262,500 points per calendar year, the entitlement to reimbursement for the additional contract dental treatments provided is reduced by 20%, from a point amount of 337,500 points per calendar year by 30% and from a point amount of 412,500 points per calendar year by 40%.
origin
The reason for the introduction of degression was, on the one hand, that large practices would have rationalization effects that they should return to the health insurance companies. On the other hand, the number of "oversized" practices or the expansion of the size of a dental practice should be reduced.
In this regard, Section 85 (4e) stated:
(4e) The statutory health insurance associations must pass on the fee savings from the reduction in remuneration in accordance with paragraph 4b to the health insurance companies. The implementation of the reduction in remuneration by the Association of Statutory Health Insurance Dentists is carried out by lowering the contractually agreed point values from the time the respective limit values are exceeded in accordance with paragraph 4b.
Effects of degression
- The dentist receives 18 points for a detailed examination according to BEMA No. 01. He receives 86.75 cents per point, for a total of € 15.42. If he falls below the highest degression level, he receives only 60% of that, i.e. € 9.25.
- The dentist receives 15 points for the removal of a multi-rooted tooth according to BEMA No. 44. He receives 86.75 cents per point, for a total of € 12.98. If he falls below the highest degression level, he receives only 60% of that, i.e. € 7.79.
(For calculation values, see evaluation standard for dental services ).
Degression led to a budget cut
However, the obligation to repay the degression amounts to the health insurance companies not only reduces the fees of the dentists concerned. If the total remuneration of a health insurance company is exhausted or exceeded, the degression also results in a budget reduction (correct: lowering the total remuneration ceiling) in the amount of the total of all degression repayments, so that the entire group of dentists in the respective federal state is collectively charged back through further recourse. The Appointment Service and Supply Act (TSVG) resolved to lift the degression as of May 1, 2019.
Degression in orthodontists
For orthodontists , the right to reimbursement for further contractual dental treatments decreased after a slightly higher amount of points: from a total of 280,000 points per calendar year, the reimbursement claim decreased by 20%, from a point amount of 360,000 points per calendar year by 30% and from a point amount of 440,000 points per calendar year by 40%.
Modifications
The degression applied accordingly to “authorized dentists”, to dentists employed by contract dentists and to dentists employed in medical care centers .
The point quantity limits in professional associations were based on the number of dental members.
The amount of points increases by 25% for relief, training and preparation assistants. In the case of part-time or non-year-round employment, the point quantity limit is reduced in accordance with the length of employment.
Sanctioning measures
In § 85 paragraph 4f SGB V, sanctioning measures against the respective Association of Statutory Health Insurance Dentists (KZV) were stipulated if the KZV does not meet the obligation after repayment of the amounts to the health insurers:
(4f) The health insurance company has a right of retention of 10 per cent against any claim by the Association of Statutory Health Insurance Dentists, as long as the Association of Statutory Health Insurance Dentists does not meet its obligations from paragraphs 4c to 4e. The entitlement to payment of the amounts withheld in accordance with sentence 1 expires if the Association of Statutory Health Insurance Dentists does not, or does not fully, fulfill its obligations for that year by the last quarterly statement of a year.
The sanction would have triggered a corresponding reduction in fees for the dental collective in the federal state concerned.
Amount of the degression repayments
The total fee reductions from the degression determination amounted to around € 100 million a year nationwide. The health insurances could freely dispose of these returned funds, i. that is, they didn't have to use them for dental treatments.
Degression deductions had to be calculated individually for each dentist. Insofar as the HVM fee assessment limits also intervene cumulatively - so that the volume of services that triggered the degression is not or at least not fully rewarded in arithmetic terms - the degression should not have any effect (in this respect).
