Doctor network
Networks of doctors and practices are associations of general practitioners and specialists from various disciplines and psychotherapists as well as representatives of other health professions (e.g. physiotherapists or speech therapists ) from the outpatient and / or inpatient sector in a region. The merger is intended to organize cross-disciplinary, local outpatient medical care in the region. In addition, the quality and efficiency of outpatient medical care should be improved through the cooperation between the various actors and institutions.
history
As early as the mid-1980s, there were first efforts to establish cooperative forms of medical professional practice. With the "Second Statutory Health Insurance Reorganization Act 1997" (2nd NOG), practice networks were established. The aim of the law was to promote new care structures in the outpatient sector through stronger networking of general practitioners. Through this closer cooperation between the contract physicians, the legislature hoped for quality improvements and more cost-effectiveness in care.
In the years that followed, the number of doctor networks increased continuously. In 2002 there were still around 200 networks nationwide in which around 10,000 resident doctors were linked, today there are around 400 networks with an estimated 30,000 doctors. Around a quarter of the resident doctors in Germany today belong to a network of doctors. There are big differences between the networks. Some bundle numerous doctors in a region, so that they have a high level of commitment and functioning management structures, have concluded contracts with health insurance companies and organize part of the medical care themselves. Others have opted for less binding structures.
Contract drafting and legal basis
Since the term practice or doctor network is not legally defined, it offers the contracting parties involved a lot of leeway in structuring their cooperation. As a result, many different networks have formed between the registered contract doctors over the years. They range from loose but regular meetings to healthcare companies with a firm contractual basis.
The legal requirement is anchored in the framework of structural contracts according to § 73a SGB V or model projects according to § 63 ff. SGB V. The abolition of the previously strong sectoral separation of tasks between outpatient (i.e. resident doctors) and inpatient care (hospital) as well as rehabilitation (aftercare) is also creating new challenges. The statutory basis is the GKV Modernization Act (GMG) (BGB, 2003), which came into force at the beginning of 2004. It is integrated care under the new rules in § 140a to § 140d defined SGB V as demand-oriented, cross-sector and modern form of care.
Forms of implementation and areas of responsibility
Usually, a loose network of 15 to 100 doctors in private practice in a city or region is created initially in order to improve local care. This results in sometimes narrow, different networks of practices or doctors between established contract doctors.
Practice or doctor networks perform the following tasks for their members:
- Joint representation of interests towards health insurance companies and politics
- Promotion and support of professional training in the independent medical practice
- Securing the market position in particular of registered contract doctors
- Commitment to free choice of doctor and freedom of therapy for patients
- Use of new contract options in the healthcare sector
- Organization of necessary and important further training without long distances for the participants
- Help and support for contract fulfillment from the network center
- Benefit from better purchasing conditions
Network control instruments
- Instruments and measures to increase patient sovereignty include:
- the implementation of patient surveys
- the use of a patient representative
- the development and distribution of own (independent) patient guidelines and patient files
- the implementation of patient days and information events
- the close cooperation with self-help groups
- Publication of patient magazines
- Instruments and measures to increase the structural, process and Result quality among others:
- professional quality and efficiency circle work with mandatory participation of the practices
- regular internal and external practice team training
- the implementation of a so-called risk management system
- Quality assurance through adaptation and implementation of evidence-based guidelines
- mandatory introduction of Qm structures as well as the binding implementation of cross-practice work and process instructions
- Certification of the network management structures according to DIN EN ISO 9001: 2008
- Development of a set of quality indicators and - based on this - the introduction of a network target and success-oriented internal remuneration system
- Conducting member surveys
- Publication of network results in the form of annual reports
- Instruments and measures to increase supply efficiency include:
- Assumption of budget responsibility for registered insured persons
- Introduction of activity and success-oriented remuneration approaches (pay for performance)
- differentiated monitoring and controlling of medical and economic indicators
- Training measures on the subject of polypharmacotherapy
Recognition and promotion
With the inclusion of practice networks in the Fifth Social Code (SGB V § 87b) within the framework of the “GKV Supply Structure Act” (GKV-VSG) of 2012, the starting shot was fired for the recognition and later also for the financial support of practice networks. The National Association of Statutory Health Insurance Physicians (KBV) developed a nationwide framework as the basis for their own guidelines for the regional associations of Statutory Health Insurance Physicians (KVen). There are now around 70 networks that have been recognized. With the Statutory Health Insurance Care Strengthening Act that followed in 2015, the legislature created the possibility that practice networks could be financially supported. Some associations of statutory health insurance physicians have already issued their own funding guidelines.
Requirements for the recognition of practice networks
In order to be recognized as worthy of funding, special requirements are placed on practice networks. Certain structural requirements must be met. In addition, certain requirements are placed on the quality of the supply and the networks must demonstrate the measures with which they want to improve quality and profitability. Structural requirements are:
size
In order to enable a regional exchange on a professional level, practice networks must neither be too big nor too small. The framework specification of the National Association of Statutory Health Insurance Physicians therefore provides for at least 20 and at most 100 contract medical and psychotherapeutic practices for one network.
composition
Practice networks are characterized by their interdisciplinary character. In order to meet this requirement, at least three specialist groups must be represented in the practice network. In any case, general practitioners must be involved.
Coverage area
In order to be able to organize outpatient medical care close to home in a region, the network practices must be located in a contiguous area.
legal form
In order to be able to submit an application for recognition, the practices must join forces in the form of a partnership, a registered cooperative, a registered association or a limited liability company. The association must have existed for at least three years when the application is submitted.
Cooperations
In order to enable comprehensive care, other health professions can be included in the practice network. Cross-sectoral cooperation with hospitals also contributes to comprehensive care. Practical networks willing to receive funding must therefore provide evidence of a binding cooperation agreement.
Common standards
Standards are to be defined for the professional cooperation intensified in practice networks. This involves quality management, participation in agreed measures for knowledge and information management, and independence from third parties (e.g. pharmaceutical companies).
management
Professional practice networks need their own network management in order to be able to build sustainable structures. In order to be recognized, the network must therefore have an office, a managing director and a medical director or coordinator.
Care goals
In addition to the structural requirements, networks for recognition by the associations of statutory health insurance physicians must explain the measures with which they want to ensure efficient care tailored to the needs of patients. On the one hand, under the heading of patient centering, it is a question of aligning medical care, but also the processes and structures in practices, more closely to the needs of patients. Under the point of cooperative professional practice, measures are summarized which should bring about an improvement in the cooperation of all those involved in the network. The better the collaboration works, the more the patients benefit.
Recognition levels
The framework distinguishes between three levels of recognition: basic level, level I and level II. Recognition is possible in all three levels - networks can join depending on their level of development and do not have to follow a recognition hierarchy. The structural requirements are the same for all levels. The requirements for the care goals increase from level to level and build on one another. However, there is no obligation to advance to the next higher level.
Success factors of medical networks
The core elements of successful networking are
- bringing together a sufficient number of resident doctors with close networking with other service providers from the region, including those from the nursing and social sectors
- the establishment of a medically dominated management company
- a cross-sector care management that is expressed in a quality-assured optimization of treatment processes
- the promotion of primary, secondary and tertiary prevention
- a morbidity-oriented evaluation for further optimization
- assuming budget responsibility for enrolled patients
- the defined distribution of success between the regional supply network and health insurance companies
- a success- or quality-oriented remuneration
Advantages of practice networks
In a practice network, the independence of the medical and psychotherapeutic activity is preserved while at the same time improving cooperation with other service providers. This enables practices to expand their range of services and work more efficiently. In addition, unnecessary double examinations can often be avoided and care can be achieved that is more tailored to the patient. Patients benefit from an improvement in quality through uniform quality standards. This leads to improved efficiency of care and a high level of patient satisfaction, which tends to be somewhat better for patients in practice networks.
Practice networks as innovation drivers
In order to improve the quality and efficiency of outpatient medical care at the regional level, practice networks often develop and participate in projects to improve local care. In addition, they are also involved in larger projects that serve to develop new forms of care.
Ultimately, under the heading of improved efficiency / process optimization, it is about how the best possible care can be organized with the available resources. Here, for example, structured processes, clear rules, but also potential analyzes help to improve efficiency.
Agency of German medical networks
Some of the large medical networks and health associations have joined forces with the Association of Resident Doctors in Germany and the NAV-Virchow-Bund in order to bundle their interests and competencies in a joint network agency and to position themselves better at the federal level. On July 8, 2011, the association “Agency of German Medical Networks” was launched in Berlin. The association is the political lobbyist for the 400 or so medical networks in Germany, wants to support its members in professionalizing and be a service provider for contract and care concepts. There are currently 22 full members organized in the Agency for German Medical Networks.
literature
- A. Fricke: Dear words, but no deeds for medical networks. In: Ärztezeitung. April 12, 2011. (online)
- S. Gieseke: Practice networks are a driver of innovation for KBV. In: Ärztezeitung. May 4th 2011. (online)
- J. Lindenthal, S. Sohn, O. Schöffski: Practice networks of the next generation: goals, distribution of funds and control mechanisms. (= Writings on health economics. 3). HERZ, Burgdorf 2004.
- J. Lindenthal: Network-internal remuneration structures. In: W. Hellmann, S. Eible (Hrsg.): Managing health networks - managing cooperation successfully. MWV, Berlin 2009.
- J. Lindenthal, V. Wambach: Customer orientation as a success factor for survival in competition. In: W. Hellmann, V. Wambach (Ed.): The strategy book for the resident doctor, options and practical tips for securing the future. MWV, Berlin 2009.
- J. Purucker, G. Schicker, M. Böhm, F. Bodendorf: Practice Network Study 2009. Chair for Information Systems II, University of Erlangen-Nuremberg, Nuremberg 2009.
- G. Schicker: Coordination and controlling in practice networks with the help of process-based e-service logistics. Wiesbaden 2008.
- J. Stoschek: Networking is lived practice. In: Ärztezeitung. July 14, 2011. (online)
- V. Wambach, J. Lindenthal: Path work in medical practice networks using the example of the health network QuE Nuremberg. In: W. Hellmann, S. Eble (Ed.): Outpatient and cross-sector treatment pathways. Quality and economy through structured treatment processes. MWV, Berlin 2010.
- V. Wambach, J. Lindenthal: Financing and remuneration from the perspective of the medical association quality and efficiency - QuE Nuremberg. In: GE Braun, J. Güssow, A. Schumann, G. Heßbrügge (eds.): Innovative forms of care in health care - concepts and practical examples of successful financing and remuneration. Deutscher Ärzte-Verlag, Cologne 2009.
- V. Wambach, J. Lindenthal: Innovative management concepts for integrated supply companies using the example of the supply network quality and efficiency - QuE Nuremberg. In: W. Hellmann: Handbook Integrated Supply. 17th update 11/08, Economica, Heidelberg 2008.
Individual evidence
- ↑ National Association of Statutory Health Insurance Physicians, Association of physicians of Germany (NAV-Virchow Bund): Doctors monitor 2016. Retrieved on February 8, 2018 .
- ↑ Practice networks. ( Memento from August 4, 2012 in the web archive archive.today )
- ^ Gesundheitsnetzosthessen.de ( Memento of the original from March 17, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Recognized practice networks according to § 87b SGB V. Internet presence of the Agency of German Medical Networks, June 2018, accessed on October 22, 2018 .
- ↑ Internet presence of the National Association of Statutory Health Insurance Physicians : Recognition and promotion of practice networks. Retrieved February 8, 2018 .
- ↑ Networking: thinking ahead! 12th Congress for Health Networkers 2017. Accessed February 8, 2018 .
- ↑ Projects from the networks. In: Internet presence of the Agency of German Medical Networks. Retrieved February 8, 2018 .
- ↑ Funded projects New forms of care. In: Internet presence of the Federal Joint Committee. Retrieved February 8, 2018 .
