The Care Performance Model
The Care Performance Model
The new model for mental healthcare in the Netherlands is known as the Care Performance Model. As the name suggests, the foundation of the Care Performance Model is built upon specific "performances."
These performances are easily recognizable by everyone and accurately reflect the care that has been provided.
The rates for these performances are determined based on the practitioner delivering the treatment and the location where the treatment takes place.
The Care Performance Model prioritizes transparency: the performances are presented in a clear and organized manner, providing an accurate representation of the care you have received.
The prices are aligned with the level of care you have received. Factors such as the professional providing the treatment, the duration of each consultation, and the location of the care all contribute to determining the cost of the care provided.
For healthcare providers, this new model results in reduced administrative burden. They are no longer required to track treatment minutes, and the regulations and checks are simplified.
This model offers both patients and providers quicker insight into the associated costs. There's no longer a need to wait until the end of a treatment trajectory, as the performances are now linked to specific days rather than being tied to longer ongoing treatment plans. Consequently, billing and claiming can also be processed much more swiftly.
Changes to the Invoice
You'll be able to see the exact dates, providers, and duration of your treatments on the invoices from your healthcare provider and in the summaries provided by your health insurance company. These invoices will contain easily recognizable information that you can verify with ease. Additionally, you'll receive these invoices more promptly, allowing you to be informed about your incurred costs and whether you need to pay any deductible sooner. Starting from January 1, 2022, the care request classification will also be included in these invoices.
Your health insurance provider will receive invoices from your healthcare provider based on the care performances delivered, and they will reimburse you accordingly. You can find details about these care performances in the digital platform provided by your health insurance provider. If your deductible needs to be applied, this will also be calculated based on the care performances.
The new Care Performance Model will be implemented on January 1, 2022. This transition requires significant adjustments to the computer systems used by both healthcare providers and health insurance companies. Consequently, it will not be possible to submit invoices right from January 1, 2022. The expectation is that invoicing will be possible by April 1, 2022 at the latest.
Types of Performances on the Invoice
The invoice will feature care performances. In an independent practice setting, there are four distinct care performances possible:
Diagnostic consultation: During diagnostics, your healthcare provider assesses your condition and identifies the issues you are facing.
Treatment consultation: During treatment, you engage in a conversation with your healthcare provider with the goal of managing your issues.
Intercollegiate consultation: If your healthcare provider deems it necessary to consult an external colleague as part of your treatment.
Travel time: If the healthcare provider needs to come to you for the treatment.
Group consultations: If you are participating in group therapy.
The cost for these performances varies depending on the professional providing the care and the duration of the consultation.
For group therapy, the size of the group also influences the cost.
Separate rates apply for independent mental healthcare providers. Therefore, these rates are different (and often lower) than the rates for mental healthcare provided in institutions. The rates are determined at a national level by the Dutch Healthcare Authority (NZa).
Impact on Your Deductible
Up until December 31, 2021, you paid your deductible once per treatment trajectory (product or DBC) of up to 365 days, regardless of the start date of the treatment trajectory.
This has changed starting from January 1, 2022. Now, for mental healthcare, the deductible is applied on a per-calendar-year basis. This change stems from a political decision.
Your healthcare provider can inform you about the financial consequences and the deductible in relation to the start date of your treatment. However, the healthcare provider cannot provide advisory on this matter. They can, however, offer advice from a care perspective. If they believe that it is essential for you to start treatment as soon as possible, they can advise you accordingly based on good professional practice. While they will inform you about potential financial consequences, this aspect does not influence their advice.
Determining If You Need to Pay Deductible
Whether you need to pay the deductible for your mental healthcare treatment depends on various factors:
Have you incurred other healthcare costs in the same year?
If you've had other healthcare expenses within the same year that were covered by the basic insurance, such as medications or hospital treatments, it's possible that you've already paid your deductible or a portion of it.
Do you have a higher voluntary deductible?
If you chose a higher voluntary deductible when taking out your insurance, your deductible amount is higher. This year's statutory deductible is 385 euros. The maximum deductible is 885 euros (an additional 500 euros on top of the mandatory deductible). If you opted for a higher deductible amount, you will cover a larger portion of your healthcare costs yourself.
Do I Need to Pay Deductible?
If you want more information about your deductible or if you are concerned about your ability to pay it, it's advisable to contact your health insurance provider.
What Is Care Request Classification?
Every patient is unique, but different patients share common characteristics. While a diagnosis is necessary, it provides limited insight into the amount of care someone requires. Care request classification is a categorization of patient groups based on the severity and quantity of their complaints and issues.
In independent practices, patients are typically treated under care request types 1 through 8. Generally, care request types 1 through 4 (occasionally 5) are treated in general basic mental healthcare (generalistische basis-ggz), while care request types 5 through 8 are treated in specialized mental healthcare (gespecialiseerde ggz).
The care request classification is conducted by the coordinating treatment provider (regiebehandelaar). They utilize a questionnaire known as HoNOS+. This questionnaire is completed by the provider themselves based on the patient's complaints and issues.
Using the answers from the HoNOS+, the coordinating treatment provider determines which care request type best aligns with the patient's complaints and issues. This classification provides information about the anticipated treatment approach and must also be included in the treatment invoice.
The care request classification is not the same as the treatment plan. The treatment plan outlines the treatment agreed upon based on your diagnosis and the goals set collaboratively with the treatment provider. During the course of treatment, the treatment provider will revisit the HoNOS+ during interim evaluations. Based on this, adjustments may be made to the treatment plan, and the treatment might potentially be concluded. Naturally, all these decisions are made in consultation with you.
Disclaimer
These texts have been excerpted from the website of De LVVP (Dutch Association of Independent Mental Health Professionals). They explicitly indicate that this information provides only a basic understanding of the Care Performance Model. The information will be further supplemented in the future. More details can be found in the regulations of the
