EBM 2000plus
EBM 2000plus is the name of the Uniform Assessment Standard (EBM) valid in Germany from April 1, 2005 to December 31, 2007 , a directory that regulates the billing of outpatient services in the statutory health insurance . First the directory should be introduced under the name EBM 2000 . Since the introduction was delayed for several years, it was then renamed EBM 2000plus .
The EBM 2000plus was much discussed from 1998 to 2005, and brought many aspects of the financing of outpatient health services to the public. On the part of doctors and other service providers, a falling remuneration for their services was criticized, which resulted from the drop in the point value. This point value, the monetary value of an EBM point, had fallen by 25% between 1993 and 1996. The statutory health insurance physicians therefore demanded a billing system that remunerated their services based on business calculations with fixed amounts. The health insurance companies on the other hand referred to the problem of unforeseen cost increases when benefits would be paid without restriction with specified amounts. With the evaluation system currently in force, the doctors alone bear the financial risk of increased service provision: the more services they provide, ie the more they work, the less money they receive per service, since the total fee for all doctors does not increase.
On January 1, 2008, the EBM 2008 came into force and replaced the EBM 2000plus. The EBM 2008 was agreed on October 19, 2007 between the National Association of Statutory Health Insurance Physicians and the central associations of the health insurance companies. Compared to the EBM 2000plus, the EBM 2008 contains even more extensive flat rates of remuneration.
history
- December 1993: Resolution of the meeting of representatives of the National Association of Statutory Health Insurance Physicians , "... to develop a new fee schedule taking into account the business requirements of the individual specialist areas as a replacement for the EBM ..." [1]
- January 1, 1996: last reform of the previous EBM.
- May 1998: Rejection of the first EBM draft ("EBM 2000") by the KBV representative assembly.
- November 2000: Presentation of the first complete EBM draft with point values.
- May 2004: Decision of the evaluation committee to introduce the EBM 2000plus on January 1, 2005 in connection with a volume control that comes into force at the same time (morbidity-related control power volumes).
- April 1, 2005: Introduction of the EBM 2000plus without the control reserve volumes.
concept
In addition to adaptations to medical progress since the previous EBM reform in 1996, fundamentally new approaches have also been included in the EBM 2000plus. The separation into a general practitioner and a specialist medical care area required by law is also implemented in the remuneration. General practitioners are not allowed to charge specialist numbers and vice versa. There is a small chapter of the services that can be billed by all doctors. These are z. B. Home visits and emergency treatment.
- Many of the previously individually assessed services are grouped into complexes and flat rates. Example: In addition to personal doctor-patient contact, the ordination complex already includes many services that were previously separately billed, e.g. B. the symptom-related examination, the issuing of a certificate of incapacity for work and the examination of the prostate .
- Age weighting of this ordination complex should take into account the different effort depending on the patient's age. In the area of general practitioner care, he is rated with 145 (6–59 years of age) to 225 points (from 60 years of age).
- The same services are sometimes rated very differently depending on the doctor's group. Example: the ordination complex (from the age of 60) is rated with 225 points in the area of general practitioner care, whereas in the area of specialist internal medicine it is rated with 230 points. If a thorough physical examination is carried out and an electrocardiogram (EKG) is made, an additional 300 points for the whole-body status and 220 points for the EKG can be billed in the GP area, i.e. a total of 745 points. In the specialist area, it remains at 230 points, since the full-body status and EKG are included in the ordination complex. Understandably, there were violent protests against the rule "unequal money for equal services". However, social courts tolerate these provisions, as they allow the corporations a wide margin of discretion in formulating the fee provisions.
- Certain services are assigned exclusively to the general practitioner or specialist care level and within the specialist area to the individual specialist areas. Example: the reflection of the bronchial tubes ( bronchoscopy ) can only be billed in the EBM 2000plus for specialists in ear, nose and throat medicine or pulmonology (pulmonology) .
criticism
In the opinion of many doctors, the EBM 2000plus does not meet the expectations attached to it. The basic idea was to achieve an economically calculated evaluation and reward for medical services. As a basis for the calculation, the National Association of Statutory Health Insurance Physicians created raw data on medical and non-medical performance parameters (time required per service, material and personnel costs of each service, etc.) and some of them were purchased abroad. Even before it was introduced, this economic part was essentially eliminated, as specific calculations showed that it was underfunded. As a result, an adjustment of the evaluation of the new fee schedule numbers to the politically approved fee volume was criticized as arbitrary. Because of their experience with earlier fee schedules, many doctors were very skeptical of the new introduction. The new fee schedule was made "tasty" for the medical profession with the promise that after the "dry spell" of an introductory phase of approx. 2 years, their services would again be assessed in euros and cents instead of in "points" (medical services are in Points rewarded. The value of a point fluctuates between approx. 1 and 5 cents, depending on the payments made by the health insurance companies. However, after the introduction of the new fee schedule, which was very costly for doctors, this commitment was revoked as it was unaffordable. Just one year after its introduction, a completely new fee schedule was discussed again in 2006. Even the EBM 2008, which came into force on January 1, 2008, did not bring the doctors any business remuneration. Higher fees have been promised for 2009.