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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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New regulation of video consultations in Germany

In order to promote the video consultations, the National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) have agreed on several new regulations. Thus, a video consultation will also be possible if the patient has not been previously treated by the doctor. For psychotherapies, the video consultations were reopened.

With the agreements made, doctors and psychotherapists can integrate the video consultation into everyday practice more easily and use it whenever they find it useful. The legislator had repeatedly demanded this as well as to build up the offer for video consultations.

A first step towards promoting video-video lessons took place as early as April 1, 2019, when the electronic visit for all indications for psychotherapy was opened. Since the beginning of October 2019, doctors from almost all specialist groups are now allowed to conduct and bill video consultations - with the exception of only laboratory doctors, nuclear physicians, pathologists, and radiologists. Likewise, authorized physicians can treat their patients via video.

It is also new that the first doctor-patient contact may take place in a video consultation. So far, the doctor had to know the patient in person first. Now, the electronic visit is also billable for "new" patients.

In order to promote the video consultations, the fee was reorganized. It was implemented since October 1 using the respective insuree, basic or consult flat rate instead of the fee order item (GOP) 01439.

The lump-sum plus surcharges will be paid in full if there is still personal contact during the same quarter. If this is not the case and the communication takes place exclusively via video, the lump sum and, if applicable, the surcharges referring to it will be reduced.

New for medical and psychological psychotherapists is that they are now able to perform and charge for certain services of guideline psychotherapy via video consultation, for which the psychotherapeutic law and the psychotherapy agreement do not specify a personal doctor-patient contact.

In addition, doctors and psychotherapists can charge for discussions that take place via video consultation, receiving the technical fee additionally to finance the costs (GOP 01450: 40 points / €4.33), which remains unchanged in terms of amount.

The extra expenses for the authentication of new patients in the video consultation – as the required master data cannot be collected automatically via the electronic health card - the health insurance will pay €1.08 per insured person. The billing will take place via the new GOP 01444 (rating: 10 points / €1.08) as a supplement to the insuree, basic, or consult flat rate.

Video consultation hours are also counted within the "chronic surcharge": GPs and pediatricians will receive the surcharge (GOP 03220 to 03222/04220 to 04222) even if one or two of the three required doctor-patient contacts have taken place by video. The three contacts must have taken place within the last four quarters.

Case conferences in nursing can now oftener be performed via video. So far, they have been possible between physicians and nursing home nurses, with whom, for the insured, there was a cooperation agreement signed (GOP 37120 and 37320).

Since the beginning of October 2019, such case conferences can also be performed by video and charged when the patient lives at home or in a protective institute. For this purpose, the GOP 01442 (rating: 64 points / €6.92) was included in the EBM (Einheitlicher Bewertungsmaβstab, German Uniform Evaluation Standard).

Case conferences and case reviews under the GOP 30210 (Hyperbaric Oxygen Therapy for Diabetic Foot Syndrome), 30706 (Pain Therapy), 30948 (MRSA Case and / or Regional Network Conference), and 37400 (End of Life Planning) are now available as video conferences.

In addition, practices for up to 50 electronic visits in the quarter will receive an additional €10 per consultation hour - in total, up to €500. The prerequisite for this surcharge is that the practice performs at least 15 video sessions per quarter. KBV and health insurance had agreed on this start-up financing during the fee negotiations in summer 2019. It is limited to two years.

The Federal Ministry of Health now has two months to study the decision. In addition to the amendments to the EBM, the new Annex 4b "Agreement on the authentication of insured persons for exclusive long-term treatment" to the "Federal Master Treaty for Medical Practitioners" was adopted and the existing Annex 31b "Agreement on the requirements for video consultation techniques" was adapted (both will be available shortly).

The full details in German can be found here.

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