Benchmark (medicinal product)
The benchmark for drugs and bandages is a term from contract law for statutory health insurance physicians in Germany and is used for economic auditing when prescribing drugs , bandages and therapeutic products .
Legal basis
Health insurance companies and associations of statutory health insurance physicians as contractual partners agree individually in accordance with the KV area in accordance with Section 84, Paragraphs 6 and 8 of SGB V, case-specific benchmarks for specific medical groups as average values. This ensures planning security for the health insurance companies with regard to the drug costs of their insured persons, since the risk of rising costs lies with the prescribing doctor. The values for the benchmarks are scaled down values for medication and bandages on the one hand and for remedies on the other hand, which were scaled down to the individual doctor. These are the prescription averages of his specialist group per quarter. The values for members and family members as well as for pensioners are determined separately. Quarterly values apply as benchmarks, but their tests are based on a calendar year.
definition
Benchmarks are average values for the upper limit of drug expenditure per patient and calendar year. They do not represent an absolute spending limit for the current year for the statutory health insurance physician. The more patients he has, the higher the volume. Guide values are therefore not limiting amounts for the care of individual patients, but an above-average consumption by one patient can be offset by below-average consumption by another patient.
Specialist groups without benchmarks
For specialist groups for whom no benchmarks have been agreed, compliance with the economic efficiency requirement and the therapeutic products directive is checked using the test procedures regulated in the test agreement. For professional associations and medical care centers , the case count to determine the benchmark volume is based on the benchmark comparison groups represented.
Exceeding the guidelines
If a contract doctor exceeds his benchmark volume by more than 15 percent, the responsible examination office initiates an examination procedure. An excess of more than 25 percent can result in recourse. If health insurance companies and KV have agreed on so-called practice features, these will be taken into account during the examination.
Individual evidence
- ↑ a b Profitability ( Memento of the original from December 5, 2010 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. National Association of Statutory Health Insurance Physicians
- ↑ a b Example of a benchmark agreement for Baden-Württemberg (PDF; 242 kB)
