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BSG: Degree of care of doctors in urban areas is decisive
(jur). Doctors and psychotherapists licensed in large cities cannot fundamentally move their practice from a poorly supplied to a better supplied district. According to the will of the legislator, the approval for relocating a practice seat in a planning area is dependent on the level of coverage of the insured in the respective district, judged on Wednesday, August 3, 2016, the Federal Social Court (BSG) in Kassel (ref .: B 6 KA 31 / 15 R).
In the specific case, it was about a psychological psychotherapist who had taken over a practice with a half-care assignment in Berlin-Neukölln on April 1, 2013. But after half a year, the former practice owner wanted to use the premises for other purposes. The psychotherapist therefore asked the admissions committee to relocate the practice to her place of residence in Berlin's Tempelhof-Schöneberg district.
The latter rejected the application and justified this with an undersupply of psychotherapists in Neukölln in the amount of 83.7 percent. In Tempelhof-Schöneberg, on the other hand, there is an oversupply with 344 percent.
The psychotherapist objected. The Appeals Committee approved their application for relocation. The new practice seat would not be a significant disadvantage for the patients in Neukölln. The definition of the degree of coverage in each district is not decisive. "The decisive factor is how well the insured person can achieve the practice," said Dirk Vallentin, chairman of the appointment committee in the BSG.
Here, the previous practice of the therapist is only about five kilometers from the previous practice and can be easily reached by public transport in twelve minutes.
The Kassenärztliche Vereinigung (KV) Berlin saw this differently. "Whether a move to a practice seat can be approved must be made dependent on the degree of coverage in the respective Berlin district," said Wolfgang Pütz, who is responsible for the admission of doctors and psychotherapists to the KV. "Otherwise everyone moves to where the private patients are sitting," said Pütz.
He also relied on a letter of intent from the Berlin Senate Administration and representatives of doctors and health insurance companies. According to this, a transfer of the practice seat should only be approved from better-supplied to poorly supplied Berlin districts.
"It is probably also a question of who's on the hat," said Ulrich Wenner, chairman of the 6th contract doctor's senate of the BSG about the dispute between the appointment committee and KV. After the judgment, this is now the KV. According to the legal provisions, a relocation of the practice seat can be approved "if there are no reasons for this under contract medical care", according to the BSG. According to the will of the legislature, in a metropolitan planning area, such as Berlin, it should be prevented that medical and psychotherapeutic care for the population in individual districts is worsened by relocating offices.
Therefore, the degree of coverage is decisive whether the relocation can be approved. Only in exceptional cases can approval be granted for other reasons, for example if a doctor can no longer work at his previous practice due to illness. fle