Community health center

A Medical Care Centre (MCC ) is an introduced by the German legislature with the SHI Modernization Act of 14 November 2003 device for ambulatory medical care.

Background

Goal of health reform in 2003 was the contributions to the statutory health insurance and thus to reduce non-wage costs permanently. Since 2004, after also medical care centers ( MVZ ) at the contractual medical ( physicians' ) can take care alongside established contract doctors in single practices or communities of practice. The law initially was not directed to the hospital area, caused, however, that hospitals increasingly had the opportunity to perform outpatient treatments.

Similar to the polyclinics of the GDR as many licensed physicians can work there as an employee, what is allowed only very limited in the conventional medical practices. Medical care centers must be multidisciplinary, ie employ specialists of different directions or psychological psychotherapists, and are under medical supervision. In the GDR and specialists doctors who worked almost exclusively in the polyclinics. These clinics were almost completely abolished in the wake of German reunification. Only facilities according to § 311 SGB V old version ( dispensary facilities ) were grandfathered under certain circumstances. The structural conditions of today's medical care centers are seldom similar clinic in contrast to the polyclinics of the GDR.

Until 31 December 2011, MVZ was also approved by each according to the SGB V providers ( besides doctors and psychotherapists pharmacists, hospitals, retirement and rehabilitation facilities as well as medicinal and Hilfsmittelerbringer ) are established, the due authorization, approval or agreement participated in the health care law insured patients. Moderator were private hospitals, pharmaceutical companies, health insurance companies or their associations, funds ( dental ) medical associations, hospital associations, support from management companies, dental technicians, et cetera. For details, were determined among other things by the Treaty Medical Law Amendment Act.

Legal basis

The legal bases form § 95 and § 140b Fifth Book of the Social Code (SGB V). Shareholder in a MVZ can only be the aforementioned foundation status in the rule. For the " medical director " of the MVZ be those of the hospital shall apply. Here, the manager does not need a member of the Statutory Health Insurance Physicians (KV) or contract physician be. For the patient has a medical center similarities with a group practice with the difference that there is no direct treatment contract arises with the doctor, but with the MVZ.

Admission and establishment

With the GKV- supply structure Act ( GKV- WTL ) may 2012 health care centers ( MVZ ) since January 1, only by licensed physicians, licensed hospitals, providers of non- medical dialysis services or by non-profit institutions involved in the medical care of the statutory health insurance ( GKV) are founded on the basis of approval, authorization or agreement to participate. In MVZ start-ups only private companies also are ( including limited partnerships, registered cooperatives ( eG ) and limited liability companies ( GmbH) allowed. Not allowed are limited companies (AG) and in the legal literature, the general partnerships are ) ( OHG ) and limited partnership (KG) majority considered invalid MVZ carrier.

Admission is on the admissions committee at the Statutory Health Insurance Physicians (KV ) for the location of the branch as a doctor or the place of establishment. The health insurance can conclude with MVZ in the context of integrated care and direct contracts. Requirements for admission are:

• At least two medical and dental half approvals in various disciplines.
• Multidisciplinary activities: MVZ is then a multidisciplinary means when operating in their doctors with different medical specialist or specialized terms. At least two specialists are therefore necessary for a medical care center. The main reason for the review is the statutory medical approval. So meeting a specialist in general medicine ( as a general practitioner ) together with a physicians working internists not a prerequisite.
• Presentation of a social contract and appointment of a medical director. The medical director is subject to any instructions in medical matters. The medical director must not be equipped with business executive powers.
• Assumption of a guarantee by all shareholders ( founders ) for the demand of competent physicians' association for the MVZ ( for start-ups since 2007 ).

Statement

The quarterly statement of MVZ runs against the Statutory Health Insurance Physicians (KV) similar from a multidisciplinary group practice. The MVZ performs the settlement of accounts with the KV. The contractual relationship is here to say between MVZ and KV. In the private medical billing provides the MVZ the claim (invoice) directly to the patient, since the private treatment contract between the patient and medical centers is. In the case of liability of the Herantretung patient and payers directly to the MVZ takes place, similar to hospitals.

Development

The number of possible MVZ founder was significantly reduced compared to the previous state since 1 January 2012. The objective is the cost savings ( share resources, such as medical technology, facilities, personnel), close collaboration of multiple disciplines with short distances, and in the relief of physicians of administrative tasks.

At 31 March 2010 there were 1,503 medical centers with 7,526 doctors, 6,206 of them employed. September 30, 2011 were 1,750 medical centers with 9,571 registered doctors, including 8,257 doctors in an employment relationship in operation. At 31 December 2011 there were 1,814 medical centers with 10,020 doctors, 8,662 of them employed.

It is striking that the proportion of salaried physicians has increased, while the share of self-employed professionals rather stagnant. With about 18 % of all medical centers have been established so far in Bavaria most.

Special Tax

Foundation

Taxation in the establishment phase is the one depending on the chosen legal form as well as the procedure of establishment. In shifting from a multidisciplinary group practice in the legal form of a civil law ( GbR, also BGB -Gesellschaft called ) in a MVZ GbR Tax- no special features, because the tax Mitunternehmerschaft is continued ( under changed physician health conditions ).

If doctors bring their practices or their shares of the business assets of group practices in the creation or extension of an MVZ GbR, this can under certain conditions in accordance with § 24 Reorganization Tax Act ( Reorganization Tax Act ) tax-neutral happen without disclosure of hidden reserves. In addition to the continuation of book values ​​is, inter alia, mandatory requirement that an operation, partial operation, or a joint venturer share with the main operating bases in the MVZ GbR is introduced.

If a medical center corporation ( GmbH exclusively ) caused by introduction of a practice or a unit of a group practice in exchange for corporate rights, § 20 Reorganization Tax Act is applicable. Here, too, is possible under certain conditions, the book value approach. Note, however, that the transferor if he has determined his win to date, according to § 4 para 3 ITA, must generate a contribution balance and thus must proceed to the determination of profits under § 4 para 1 Income Tax Act detection of a transition profit. Furthermore, the hidden reserves are at book value guide undifferentiated from the person of transferring over to all shareholders. This can lead to the result that deferred tax burdens go from one to the other shareholders at the expense of his assets. Unless § 20 Reorganization Tax Act applicable, the shares of the corporation so-called granted to provide for continuation of book values ​​" tainted " shares dar. event of a sale of such shares within seven years from the transfer occurs a special taxation of income under § 22 Reorganization Tax Act a.

Current Taxation

For the choice of legal form from a tax perspective, the overall tax burden is crucial.

The partners of a partnership generate income from self-employment. Each shareholder is entitled to tax its share of profit directly. If it is a commercial partnership, are business income. For business income, the partnership is liable to trade tax, the business tax shall be deducted at the shareholders on their income tax.

For corporations formed at the level of society corporation tax and trade tax on the taxable profit. If the shareholders are in the corporation within the employment relationship, provide the salaries profit-reducing operating expenses dar. At the shareholder level is to be paid in the salary payments of income tax. Distributions of the Company, if necessary taxed under the flat tax, currently 25 % plus solidarity surcharge and church tax lump sum.

Criticism

The Scientific Services of the German Bundestag point to the following public criticisms of MVZ: " MVZ are always subject to public criticism, especially from the medical profession, which, given the increasing competition in the outpatient sector may come as no surprise. This is mainly criticized that the " penetration " of management companies, private hospital - makers and hospitals in the ambulatory care market free choice of doctors of patients restricts, jeopardizes the freelancing of medical activity and established specialist practices displacement. In fact, the MVZ ( 88 722 approved practices MVZ 1,454 vs.. ) But still lead in absolute terms a niche. " In the discussion so far no opinions or practice examples are given with respect to the criticisms.

After the dissolution of the East German health care system and their polyclinics in the early 1990s is in this point that instead of a U-turn. With a continuous development with preservation of polyclinics some mistakes ( lack of doctors, long distances ) could have been avoided or mitigated in the territory of the new Länder.