New rules for telemedicine: video consultations to become more widespread

Contents

New rules for telemedicine will apply in Germany from March 1. These are set out in the "Agreement on the requirements for ensuring the quality of care for telemedical services in accordance with Section 87 (2o) SGB V", which the National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) have concluded. With the Digital Act (Digital-Gesetz, DigiG), the Federal Ministry of Health had previously obliged the associations to create uniform regulations for video consultations. The aim is to improve patient care during these consultation hours and subsequent measures.

The new rules primarily relate to video consultations as a telemedical service between doctor and patient as well as to consultations, i.e. telemedical meetings between different doctors or other service providers. Among other things, doctors' surgeries should offer video consultations where medically appropriate. Access should be low-threshold and there should be no discrimination based on patient characteristics such as type of insurance. The offer of video consultations must be advertised in the practice rooms.

Specialists participating in statutory health insurance should also be available to other doctors for teleconsultations, i.e. in an advisory capacity as part of the care provided to patients by other doctors. Doctors may also conduct video consultations from outside their practice if a fully equipped teleworking station is available there, including access to the telematics infrastructure. However, they are not allowed to be outside Germany.

Unknown patients

There are also rules for unknown patients. They are defined as those who have not had any personal doctor-patient contact in the practice conducting the video consultation in the four quarters prior to the video consultation. Unknown patients may not be prescribed narcotics or other potentially addictive medications via video consultation.

In addition, unknown patients must undergo a so-called initial assessment procedure to assess the urgency of the need for treatment. This is to be done using software.

Preference given to patients in the vicinity

From 1 September, patients will also have to be prioritized according to urgency for video consultations. In addition, a practice should give preference to patients living nearby for video consultations. This should improve follow-up care. Practices are also obliged to use the electronic patient file (ePA) as part of the video consultation, unless the patient has objected to this.

The practice is not permitted to restrict the services provided in the video consultation – to sick notes only –, for example. Referrals, referrals and prescriptions must be sent to the patient or posted on the same day as the video consultation.

The Central Association for Digital Healthcare criticized the provisions of the agreement as over-regulation, referring in particular to the requirement for video consultations close to the patient's home. The software to be used for the initial assessment of an unknown patient. The KBV board rejected this criticism, pointing out that this would only implement requirements from the Digital Act.

Gradual relaxation

Video consultations have been available as a statutory health insurance benefit in Germany since 2017. Initially, this only applied to very limited cases, primarily for the follow-up of injuries and skin diseases, musculoskeletal disorders and monitoring the healing process after operations. And within this narrow framework, video consultations were again only permitted for patients who the doctor in question had previously seen in person at the practice.

There was a significant change in May 2018: the German Medical Assembly decided to lift the ban on remote treatment still in force in Germany, which had restricted video consultations to patients known to the doctor. The Medical Council's decision was implemented by the medical associations of the various federal states, and in April 2019, video consultations also became billable for many other applications. Since October 2019, a patient's first contact with a doctor has also been billable via video consultation.

Furthermore, the regulations were relaxed in the context of the coronavirus pandemic: additional remuneration was provided as start-up funding for practices that introduced video consultations and the previously applicable volume limit was lifted.

(mki)