Anyone who has an emergency during off-peak times in BW may have a harder time finding a doctor in the future. The reason is a court ruling. For Manfred Lucha (Greens) this was avoidable.
After a ruling by the Federal Social Court on the social insurance obligation of pool doctors, the Baden-Württemberg Health Minister Manfred Lucha (Greens) sharply criticized Karl Lauterbach’s (SPD) Federal Ministry of Health. As a consequence of the ruling, eight of 115 emergency practices in Baden-Württemberg will remain closed with immediate effect, according to the Association of Statutory Health Insurance Physicians (KVBW). Six more will be partially closed.
The reason for this is a ruling by the Federal Social Court, according to which so-called pool doctors – for example retirees – are not automatically self-employed in emergency services and are therefore subject to social insurance contributions. The existing system cannot be continued in its current form, as the KVBW announced. An emergency plan has been in effect since Wednesday. The emergency services and emergency rooms are not affected by the ruling.
Lucha wants exemption for pool doctors
The Federal Social Court’s ruling could have been prevented, Lucha told SWR. Several federal states, including Baden-Württemberg, had called for an exception, but the proposal was rejected by the Federal Ministry of Health. This is beyond all reason, Lucha continued.
Outpatient medical care outside of regular consultation hours is one of the indispensable interests of the common good, said Lucha. The legal basis for the medical on-call service in BW in its current and well-functioning form has now been withdrawn.
In his capacity as chairman of the Health Ministers’ Conference, the Green politician announced a further push for an exception to the social security obligation of pool doctors.
SPD demands power from Lucha towards KVBW
The health policy spokesman for the SPD parliamentary group, Florian Wahl, told the German Press Agency that the Minister of Social Affairs now needs a word of power. “As a supervisory body, he is now responsible for requesting the security order for the emergency service from the Baden-Württemberg Association of Statutory Health Insurance Physicians.” He shouldn’t let the KVBW fool him.
Eight emergency practices have to close
According to the information, the Emergency practices in Geislingen (Göppingen district), Beech (Neckar-Odenwald district), Schorndorf (Rems-Murr district), Möckmühl (Heilbronn district), Waghäusel-Kirrlach (Karlsruhe district), Künzelsau (Hohenlohekreis), Bad Säckingen (Waldshut district) and Schopfheim (Lörrach district).
In addition, there are restrictions in practices Mühlacker (Enzkreis), Bietigheim-Bissingen (Ludwigsburg district), Rastatt, To sing, Herrenberg (Böblingen district) and Villingen-Schwenningen (Black Forest-Baar district). The emergency practices there no longer open at all or only partially during the week and concentrate on the weekend and the holidays. According to the KVBW, opening times will also be shortened in many others.
This is how Nikolai Vack from the SWR legal department assesses the verdict:
Emergency medical service: 3,000 pool doctors will be eliminated
Owners of medical offices, i.e. contracted doctors, are obliged to be on call. So-called pool doctors have previously been able to take part in on-call duty on a voluntary basis. According to the KVBW, these are, for example, retirees or hospital doctors who conclude an agreement with the relevant association of statutory health insurance physicians. Pool doctors are doctors who work voluntarily on call and are often not insured through the Association of Statutory Health Insurance Physicians.
To date, the approximately 3,000 pool doctors have provided around 40 percent of the services in emergency practices and medically necessary home visits. According to the KVWB, if social insurance requirements come into force for all doctors, this will not be possible either financially or organizationally. KVBW board members Karsten Braun and Doris Reinhardt said the ruling forced them to take this emergency brake. The loss of pool doctors cannot be compensated for quickly.
According to KVBW, this emergency brake is effective for at least three months. Only when the written ruling from the Federal Social Court is available can the association reorganize the medical on-call service in a legally secure manner. When asked by SWR, the KVBW cannot yet say that many of the doctors are actually classified as not self-employed. This can only be checked once the verdict is in writing and the details are known.
Federal Social Court ruling causes closures
The stumbling block was a ruling by the Federal Social Court in Kassel. A dentist who had repeatedly taken on emergency services as a so-called pool doctor had sued. The pension insurance company assumed that he was self-employed. However, the 12th Senate decided on Tuesday that participation in the medical on-call service does not automatically lead to acceptance of self-employment.
Rather, the man found himself in “a structure organized by a third party in which he fit in under the influence of others.” The Baden-Württemberg Association of Statutory Health Insurance Physicians, for example, assigned him to services and provided him with instruments. As a result, it was said that he was subject to compulsory insurance.
Emergency plan for the emergency medical service: consequences for the people in the country
The emergency service should therefore continue to be guaranteed – but not to the same extent as before. The resident doctors couldn’t handle that. Standard care is already difficult enough, as around 1,000 doctor’s seats are currently unoccupied. However, there should be no changes to the services organized by regional doctors, such as the ophthalmological and ear, nose and throat emergency services. The children’s emergency practices will also remain in place.
Warning of effects on emergency medical care
After the verdict, several associations warned of serious effects on emergency medical care. The general practitioners’ association said there was a lot of pressure in practices. Giving on-call services to pool doctors has so far been an important and uncomplicated relief. This option is now no longer possible.
The state medical association expected significantly longer waiting times. and appeals to doctors and patients to keep a cool head. The chamber demands that politicians must provide solutions and framework conditions that will enable a viable emergency service again.
Emergency departments fear greater demand
The Baden-Württemberg Association of Statutory Health Insurance Dentists (KZV) reacts calmly to the judgment and does not draw any conclusions. This is a case-by-case decision, she said in a written statement. It is still unclear whether this will have any subsequent impact. However, nothing will change in the short term for patients in the country.
The emergency services and emergency rooms are not affected by the ruling. The children’s emergency practices will also remain in place. However, the district council, community council and the hospital association fear that more people will now come to the emergency rooms – even without a good reason. However, it was said that this was not affordable due, among other things, to the tense personnel situation.
A lot more work for practicing doctors
The medical association Medi fears restrictions for patients. As a result of the new regulation, resident doctors will have to handle emergency services in parallel in the future, said Norbert Smetak, chairman of the Medi-Verbund. This means reduced emergency service times, fewer consultation hours in standard care and a further rush to hospital emergency rooms. According to its own information, the association represents around 5,000 practicing physicians.
The Virchowbund even warned of a collapse of the emergency medical service in Baden-Württemberg. The Federal Social Court has effectively suspended a tried-and-tested emergency service structure with immediate effect, said state chairwoman Brigitte Szaszi. That doesn’t mean anything good for the patients. At night you will have to wait hours for the emergency service. The emergency rooms would be overcrowded. This poses a massive threat to medical care again. Resident physicians are also organized in the Virchowbund.