HzV is a care model in which GPs play a central role in managing their patients’ medical care. The goal is to coordinate medical services, avoid duplicate tests, and ensure holistic care. Patients commit to consulting their general practitioner first in case of health concerns. The GP then coordinates referrals, diagnostics, and further treatments. Participating physicians receive additional remuneration, while patients benefit from improved, continuous treatment processes and potential advantages such as shorter waiting times or health programs.
Bureaucratic Challenges of HzV
Despite its advantages, the bureaucratic challenges of HzV are a major drawback and point of criticism, arising mainly from the complexity of contracts and additional billing requirements:
1. Variety of Contract Types: There are selective contracts (add-on contracts to collective agreements), which allow GPs to bill for additional services, and full-care contracts, which cover complete care by GPs.
2. Complex Billing: GPs must navigate different billing routes and payment systems, as services under HzV are often handled outside the collective agreement billing.
3. Increased Documentation Effort: HzV contracts often require detailed documentation of services rendered to ensure they are billable. These requirements vary by contract and health insurance provider, adding to the workload for practice staff.
The differing regulations between contracts (e.g., documentation requirements, billing modalities) result in increased administrative work for primary care practices, complicating their operations and impacting the efficiency and quality of care.
Integration of the HÄVG Validation Module into Order Entry Systems
Billing software solutions can reduce these additional burdens, but at medicalvalues, we go a step further by integrating the HÄVG validation module directly into our Order Entry System. This enables early validation and management of care processes. During the input of diagnostic measures, the rules and requirements of family-practitioner-centered care can be verified. This validation module performs key functions, providing significant benefits for both physicians and patients:
1. Automatic Contract Validation & Error Prevention: The module checks in the background whether the requested lab service is covered under the HzV contract for the specific patient. This helps identify deviations or inadmissible requests early, reducing billing errors and avoiding unnecessary follow-up queries.
2. Standardization of Lab Requests: The module ensures that lab requests comply with HzV-specific requirements, increasing the efficiency and accuracy of processing.
3. Time Savings: Since the system automatically checks for HzV compliance, administrative work for physicians and staff is significantly reduced.
4. Enhanced Patient Management: Integration into the Order Entry System helps guide treatments within the desired framework, enabling physicians to request services that can be efficiently processed under HzV.
Overall, integration into the Order Entry System improves process efficiency and ensures compliance with HzV requirements in daily practice. Laboratories also benefit, as standardized requests aligned with HzV guidelines lead to increased efficiency and economic advantages. With the HÄVG validation module integrated, laboratories can enhance the appeal of their offerings, attract more clients, and increase revenue. Notably, certain specialist services under HzV, usually billed via the EBM, can be converted to services billed according to GOÄ (possibly discounted in private billing groups).
Integration of the HÄVG Validation Module into the Order Entry Process by medicalvalues
- Creation of a new lab order in the medicalvalues Order Intelligence system, with an internal check to determine if this is the first order in the current quarter
- One-time retrieval of the physician’s contract partner ID (HÄVG-ID) and quarterly identification of all HzV contracts the physician participates in
- Verification of whether the insurance provider ID (Kassen-IK) of the patient’s health insurance is included in any of the contracts the physician participates in
- Verification of the patient’s participation in the corresponding contract
- Automatic assignment of the appropriate billing type in the Order Entry System
Conclusion
The family-practitioner-centered care offers great opportunities to improve healthcare but also brings bureaucratic challenges. Integrating the HÄVG validation module into digital systems such as Order Entry solutions can significantly alleviate these challenges. Such technologies not only ease the workload for physicians but also improve the quality of care and enhance communication efficiency between GPs, laboratories, and health insurance providers. A smart step toward more modern and patient-centered healthcare!