G-BA facilitates access to out-of-hospital intensive care

24.07.2023 17:29

The Federal Joint Committee (G-BA) has changed its guidelines on out-of-hospital intensive care, for example to enable continuous care for patients requiring ventilation. The G-BA wants to counteract possible bottlenecks if, according to the will of the legislature, these special services can only be prescribed in accordance with the directive on out-of-hospital intensive care (AKI) from October 31, 2023.

Specifically, the G-BA has temporarily relaxed the regulation for assessing the so-called weaning potential. It also permanently expands the circle of prescribing and potential-assessing doctors. The reason for both steps were indications from the health care system that there might be too few qualified doctors.

Dr. Monika Lelgemann, impartial member of the G-BA, said: “The care of patients in out-of-hospital intensive care is a complex and demanding service for an extremely heterogeneous group of patients. Before the regulation - according to the legislative requirements - patients who are ventilated or have a tracheostomy tube must be checked regularly to see whether ventilation is still necessary. This so-called potential assessment requires specialist medical qualifications and experience. As a result, these important requirements must not lead to the necessary prescriptions no longer being possible because there is a lack of qualified doctors. That's why today we have found a practical way to avoid bottlenecks. When it comes to out-of-hospital intensive care, many details are already specified by law. However, what we as the G-BA can regulate, such as the requirements for the qualifications of the prescribing or potential-assessing doctors, we use in the interests of those affected. Because we want to support functioning and well-established care and maintain continuity of care to the greatest possible extent.”

Until the end of 2024: exception to the potential assessment

The law stipulates that a so-called potential assessment must take place before any out-of-hospital intensive care is prescribed for ventilated or tracheostomy-cannulated patients. This involves checking whether it is possible to completely wean patients or switch them to non-invasive ventilation or remove the tracheostomy tube. The exception now supplemented by the G-BA in its guidelines applies until December 31, 2024: In the event that a qualified doctor is not available in time, the potential assessment during this time is not a mandatory requirement for the prescription of out-of-hospital intensive care. However, the potential survey must be carried out as soon as possible and by the end of 2024 at the latest.

Doctors who raise the potential of children, adolescents and young adults

The G-BA has adapted the qualification requirements to assess potential specifically for children, adolescents and young adults who require ventilation. In addition to doctors from the field of pediatric and adolescent medicine, the G-BA also provides for specialists from other medical areas - however, all of them must have additional pneumology qualifications. have several months of professional experience in treating the specific patient group in specialized facilities. This is intended to better meet the special medical needs of these age groups.

Doctor groups authorized to prescribe

The currently planned authorization for general practitioners and certain specialist groups to prescribe will be expanded. The authority to prescribe can always be granted by the Association of Statutory Health Insurance Physicians if the doctor has and can demonstrate competence in dealing with ventilated or tracheal cannulated insured persons. This means that contracted doctors from other specialist groups who already care for these insured people can continue to provide care.

Come into effect

The decision will soon be published on the G-BA website and, at the same time, submitted to the Federal Ministry of Health (BMG) for legal review. If the BMG has no legal objections, the decision will be published in the Federal Gazette and comes into force one day later.

Home Health Care Directive: No longer transitional arrangement

Services for out-of-hospital intensive care can also be prescribed in accordance with the G-BA's Home Nursing Guideline (HKP-RL) up to and including October 30, 2023. The legal basis required for this transitional regulation will no longer apply from October 31, 2023. The G-BA has therefore rejected the patient representative's request to provide for a longer prescription option in the HKP-RL. The patient representatives' request to call on the legislature to extend the transitional regulation by two years was also rejected.

Background – Prescription of out-of-hospital intensive care

Non-hospital intensive care is a complex, individually tailored range of services. It is aimed at patients who are at risk of life-threatening health crises on a daily basis and who therefore have a particularly high need for medical treatment. For example, nursing staff monitor respiratory and cardiovascular functions, operate a ventilator and use inhalation and suction devices.

Since October 2020, the entitlement to benefits for out-of-hospital intensive care has been based on a new legal basis (Section 37c SGB V). Within this legal framework, the G-BA has specified further details on the content and scope of the services in the directive on out-of-hospital intensive care and has specified which requirements apply to the regulation. With the expiry of the transitional regulation in the Home Nursing Guideline, the guideline for out-of-hospital intensive care will be mandatory from October 31, 2023. At the same time, the entitlement to benefits for out-of-hospital intensive care under the Home Nursing Directive no longer applies; this passage will be deleted there after October 30, 2023.

The National Association of Statutory Health Insurance Physicians (KBV) offers detailed information for prescribing and potential-assessing doctors: To the information on the KBV website