During the pandemic, the G-BA introduced special regulations for hospital care. Based on their good experiences with these, the G-BA has now updated the “centre regulations” directive in Germany, to introduce some of these special regulations into German routine clinical practice.
One of these is the virtual consultation between hospitals when treating patients with Covid-19 that are requiring intensive care.
Directive on centre regulations in Germany
Since 2020, hospitals that are performing “special services” can receive financial supplements for this. To this end, the G-BA defines “centre regulations” in a directive detailing these special services and the associated quality requirements, such as type and number of departments and minimum case numbers.
These centre regulations currently exist in Germany for the following:
- Heart centres
- Lung centres
- Neurovascular centres
- Oncology centres
- Paediatric oncology centres
- Rheumatology centres
- Trauma centres
- Centres for rare diseases
- Nephrology centres
- Other designated centres
Minimum standards in centre regulations for telemedical services
Centres offering telemedical services need to meet certain minimum standards in terms of technical equipment, such as:
- high-resolution, always available audio- and video-sharing facilities in real-time,
- reflecting the current standard of technology and
- allowing patient examination by the clinician to a high quality
- access to original data including imaging to allow recommendations on diagnostics and therapies.
Centres for intensive medical care with digital connections (IDV centres)
Because of the intensive care needs of patients hospitalized with Covid-19 and the nature of the infectious disease, so called “intensive-care digitally-supported networks” (IDV centres) were set up across Germany. These 4 IDV centres were digital networks between hospitals with expertise in treating patients in intensive care. Hospitals held joined consultations on the therapy and care plans using audio and video conferences.
In February 2021, the G-BA extended the supplemental pay in the “centre regulations” in Germany to also include consultation services from special clinics within IDV centres. In December 2021, they further extended the agreement until 31 March 2022.
Integration of IVD services into routine clinical care
To allow the continued reimbursement of these services provided by IDV centres beyond March 2022, the G-BA agreed on an update to the “centre regulations” directive.
The expert knowledge of heart and lung centres about treating patients in intensive care and/or requiring long-term ventilation should remain to be available to other hospitals that are treating patients with Covid-19.
However, outside of the supplemental pay for IDV centres, this knowledge sharing was not funded in the flat rate payments of the DRGs. Now, this was amended, so heart and lung centres can be reimbursed appropriately.
The G-BA agreed this adjustment on 18 March 2022, and it came into force on 1 April 2022. The G-BA added special definitions of the minimum standards required for offering virtual (telemedical) services. These requirements have largely been informed by the successful innovation funds project “TELnet@NRW”, which tested the use of a shared digital infrastructure for intensive care and infectious disease care. In addition, the G-BA based their requirements on the guideline “Telemedicine in intensive medicine” from the German Society for Anaesthesiology and Intensive Care Medicine.
Heart and lung centres can now agree to collaborate with other hospitals via telemedical services, using the DRG system with the secondary diagnosis code for SARS-CoV-2. The centres need to have treated at least 50 inpatients in intensive care with this secondary diagnosis in 2020.
Further reading related to directives and minimum standards
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