Home office for doctors
Changes to contract doctor law and professional law
Section 24 of the Licensing Ordinance for Panel Doctors (Ärzte-ZV) was amended by the DigiG to include paragraph 8, which now introduces the option of working from home under panel doctor law.
It states: "The contract doctor's work may be provided in the form of video consultation hours outside the contract doctor's office, provided that the contract doctor fulfills his obligation under Section 19a (1) sentences 2 and 3 (consultation hour obligation) at the location of the contract doctor's office." Under contract doctor law, the new regulation also allows doctors to work from home.
Under contract doctor law, a so-called secondary place of business was previously required. This has now been changed by the DigiG, which is why it is no longer necessary to apply to the relevant Association of Statutory Health Insurance Physicians (KV) for a secondary establishment. In addition to registering with a certified video service provider, all that is required is notification to the KV. Confirmation or approval from the KV, on the other hand, is not required. As a result, video consultations are to become an integral part of medical care in the future and represent a sector-specific special regulation of the place of service.
The remote treatment regulation in Section 7 (4) of the Model Professional Code for Doctors (MBO-Ä) has already been liberalized under professional law. This regulation has since been adopted accordingly in the professional regulations of doctors in all federal states, e.g. in Section 7 (4) of the professional regulations of the Baden-Württemberg State Medical Association (BO LÄK BW). At the 121st German Medical Congress in 2018, it was initially clarified that all existing legal framework conditions continue to apply. In particular, the professional regulations governing the establishment and practice of a medical practice must also be observed when providing medical services in the context of remote treatment.
Pursuant to Section 17 (1) MBO-Ä - a corresponding provision can also be found in Section 17 (1) BO LÄK BW - the exercise of outpatient medical activity is generally tied to the establishment of a practice, meaning that video consultations were previously only permitted on these premises. However, professional law permits medical activity beyond the practice location at two other locations, including the home office, in accordance with Section 17 (2) MBO-Ä and exceptions to the link between medical activity and the establishment in accordance with Section 17 (2) BO LÄK BW. This means that even before the changes introduced by the DigiG, conducting video consultations at locations other than the practice location was justifiable under professional law.
Minimum consultation hours for face-to-face consultations
Despite the possibility of providing medical services from home via video consultations, minimum consultation hours are prescribed at the registered office of the contract doctor. According to Section 19a (1) Ärzte-ZV, panel doctors must offer at least 25 hours a week in the form of consultation hours for patients with statutory health insurance. If no full care mandate is exercised, the consultation hours are reduced proportionately. Doctors who participate in specialist care (Section 73 (1a) sentence 1 SGB V) and belong to the groups of doctors providing basic care and patient care close to home must offer (at least) 5 hours of these hours per week as open consultation hours without prior appointment. These regulations ensure that sufficient presence and accessibility of doctors is guaranteed despite the extended possibilities for home office and video consultations.
Requirements for video consultations
In principle, video consultations are possible with almost all groups of doctors if it is medically justifiable, the necessary medical care is exercised and the patient is informed about the special features of exclusive consultation and treatment via communication media.
Quality assurance in the implementation of video consultations is regulated in Annex 31b BMV-Ä of the National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband). Further details on the technical procedure for video consultations in SHI-accredited medical care are determined in accordance with Section 365 (1) SGB V. Quality assurance focuses on compliance with data protection and medical confidentiality. The agreement regulates the requirements for the technical prerequisites for conducting video consultations in SHI-accredited medical care.
The video consultation must take place in closed rooms that guarantee adequate privacy and ensure data security and a trouble-free process. At the beginning of the video consultation, all persons present in the room must be introduced on both sides. It must also be ensured that the IT systems comply with the necessary technical and organizational measures (TOM) and that the transmission of the video consultation is adequately protected by suitable TOM. In addition, special requirements are placed on the video service provider in accordance with Section 5 BMV-Ä. Furthermore, obtaining consent for data processing and informing patients about the requirements for participants must also be taken into account.
In summary, doctors therefore need
Internet connection with the firewall settings recommended for practices
Screen (monitor/display), camera, microphone, loudspeaker
Consent of the patient
Current models show that GPs, ophthalmologists and dermatologists in particular, but also pediatricians, can benefit from this development. The option of working from home means that video consultations can be used more effectively. Larger units, such as medical care centers (MVZ), also benefit considerably from this.
Regulations for dentists and psychotherapists
Since July 1, 2020, video consultations and video case conferences have also been possible in contracted dental care via defined standards. However, video consultations and video case conferences are only intended for insured persons who are assigned a care level in accordance with Section 15 SGB XI, receive integration assistance and cannot visit the dental practice due to their need for care, disability or restriction, or can only do so with great effort, as well as for insured persons for whom dental services are provided under a cooperation agreement in accordance with Section 119b (1) SGB V (see Sections 87 (2k), 87 (2i) SGB V). When conducting video consultations or video case conferences, the provisions of the agreement on the requirements for technical procedures for video consultations pursuant to Section 291g (5) SGB V (Annex 16 BMV-Z) must be observed.
For psychotherapists, initial medical contact via video consultation is only permitted to a limited extent. In the case of psychotherapeutic treatments, the initial diagnosis, indication and information must take place in direct personal contact (Section 17 (2) of the Psychotherapy Agreement, Annex 1 BMV-Ä). However, changes are planned: According to Section 87 Para. 2p SGB V, the partners of the federal framework agreements are to agree the necessary specifications for the provision of psychotherapeutic consultations and probationary sessions within the framework of a video consultation by December 31, 2024.
Remuneration
With the DigiG, the evaluation committee is to lift the quantitative limit on services provided via telemedicine in order to improve remuneration for video consultations. Previously, the volume limit was 30%. Remuneration for video consultations is no longer to be based on fixed amounts, but on treatment. The evaluation committee is to determine under which conditions and to what extent services can be provided as part of a video consultation. The stipulations should enable the provision of video consultations to a wide extent. Quality surcharges can also be levied in the decisions. The only limitation to be taken into account is that of the standard practice service volume, as telemedicine is not intended to extend case limits indefinitely.
The legal adjustments to professional and contract doctor law create the basis for doctors to be able to work from home, at least in part. The obligation to hold consultation hours at the contract doctor's practice remains in place in order to ensure continuous and quality-assured patient care. In addition, however, a much more flexible working arrangement is made possible. However, compliance with data protection regulations will also have to be observed in the future. Video consultations on the beach are therefore still not possible.
Status: 05.08.2024