Doctors Do not lead unrestricted branch offices

Verdict: Physicians are not allowed to open branches without restriction

10.02.2011

Doctors may only open a branch practice under certain conditions. The Bundessozialgericht Kassel has set the framework for the opening of several practices in a recent ruling relatively narrow.

The Federal Social Court ruled that any branch offices of medical practices are only allowed if they are not too far from the headquarters, because the quality of treatment for the patients at the new location should improve, without the patients at the first practice seat worse off. In total, according to the judgment of the Federal Social Court, a maximum of two branches are permitted (Az: B 6 KA 7/10 R).

Improving medical care is crucial
Whether or not the medical care at the new practice location improves without the quality of the treatment at the head office being impaired is determined by the judgment of the Federal Social Court to a significant extent by the distance between the first doctor's practice and a possible branch office. In the case to be negotiated a pediatric cardiologist from Fulda wanted to enforce the opening of a branch practice in Bad Nauheim. After he had prohibited the Marburg Social Court the opening, as the two practice sites are 128 kilometers apart, the cardiologist moved to the Federal Social Court in Kassel, which now confirmed the verdict. The judges at the Federal Social Court also took the position that because of the great distance, the care of the patients in the first practice would be jeopardized if the doctor treated patients 128 kilometers away.

Doctor must be present in case of medical emergencies
Although the doctor wanted to practice only about six hours a week at the new location, but since he is the only pediatric cardiologist in Fulda, he could not be in time in acute situations and medical emergencies in time at its headquarters, the Federal Social Court. The doctor, with the help of his lawyer, tried to persuade the court that his patients' emergencies were not grounds for refusal for a branch practice, since his work consisted mainly of ultrasound examinations and none „Emergency activity“ be. As already the social court Marburg (Az: S 12 KA 160/09) before, however now also the Federal Social Court has forbidden the doctor the opening of the branch.

Exception of restrictions for medical care centers
In a further ruling on the maximum number of branch practices, the Federal Social Court decided on Wednesday that this regulation does not apply to so-called medical care centers (MVZ). As well as the lower courts - the Social Court of Dresden (Az: S 11 KA 46/08) and the Saxon State Social Court (Az: L 1 KA 8/09) - the Federal Social Court came to the conclusion that the rule of the maximum two branch practices per doctor only for the doctor as a person, but does not refer to the legal form of the MVZ. Because here usually work several doctors (sometimes in permanent employment) under one roof, so that no corresponding restrictions on the quality of treatment can be expected. However, the physicians working in an MVZ are still bound to practice in a maximum of two branches. In the procedure of the Federal Social Court, the judges had to decide on the concern of a MVZ in Dresden, which already has two branches and wanted to open two more. The Kassenärztliche Vereinigung had prohibited the opening of further branches on the grounds that generally a maximum of two branches were allowed. The Federal Social Court decided that the Kassenärztliche Vereinigung now has to decide on the basis of the judgment.

In view of the discussion, in order to find the problem of the young doctors at all a cash-register approved location, without having to dig deep into the pocket for taking over an existing medical practice, it seems only logical that the Federal Social Court the framework for the opening of branch practices relatively stuck tight. Young physicians in particular often have bad prospects, especially in cities. The market is busy. And since physicians also demand substantial sums of money for the transfer of the practice even in the case of personal retirement - the practice sale often forms part of the old-age insurance - the advancing physicians have no other option than to shop. (Fp)

Image: Claudia Hautumm