First of all, I would like to wish all my readers a successful and especially healthy new year 2023. This year we will have to worry less about the effects of the pandemic, the MS-specific topics will thankfully again come to the forefront of scientific discourse. I will, as usual, explain and comment on these developments for you – and of course we will continue to discuss the practical aspects of MS care here. I look forward to another year of DocBlog.
I would like to start the new year with a health policy topic that, in my view, will have significant implications for MS care: On December 15, 2022, the Federal Joint Committee (G-BA – the highest body of joint self-administration in the health care system) added multiple sclerosis to the outpatient specialized medical care (ASV) § 116b SGB V directive.
Outpatient instead of inpatient treatment
What does this decision mean? For this, it must be kept in mind that in Germany we traditionally have a pronounced sectoral separation between outpatient and inpatient care. Nowadays, however, many, even complex diseases, such as MS, are treated on an outpatient basis. A fact that many affected patients welcome.
Doctors working in hospitals in Germany, however, are only allowed to provide outpatient treatments at the expense of statutory health insurance in exceptional cases or under certain conditions (e.g., in a university outpatient clinic). This is problematic given the increasing “ambulantization”. Because on the one hand, hospitals have special medical expertise for many complex diseases, and on the other hand, the diagnostic and therapeutic possibilities of a hospital (which are particularly needed for complex diseases) are sometimes significantly greater than those of a doctor’s office.
Therefore, in recent years, politics has been trying to involve hospitals in outpatient care, i.e. to advocate for so-called cross-sector care. In 2004, the legislator introduced the directive on outpatient treatment in hospitals to open clinics for outpatient care of people with complex disease patterns. This specialized medical offer (also known as §116 outpatient clinic) is now gradually being replaced by current ASV offers.
ASV for complex and difficult-to-treat diseases
The offer of outpatient specialized medical care (ASV) is primarily aimed at patients with complex and difficult-to-treat diseases. The principle is that specialized doctors of various disciplines work together in a team and coordinate the diagnosis and treatment of the respective disease in this team. An ASV can be offered by hospitals as well as specialist doctors in private practice and medical care centers.
In the past, the G-BA has already defined disease-specific ASV requirements for a large number of diseases. For example, for gastrointestinal tumors and tumors of the abdominal cavity, lung tumors and tumors of the thorax, rheumatological diseases in adults and in sarcoidosis – and since December 15, 2022, there is now also a G-BA resolution for multiple sclerosis (https://www.g-ba.de/beschluesse/5804/).
After the resolution comes into force, the participants can form a corresponding ASV team, which includes neurologists, urologists, ophthalmologists and radiologists for the ASV MS, and treat patients within the framework of this special care offer.
I actually expect an improvement in the care of MS patients through the introduction of the ASV. – The prerequisite, however, is that the ASV is also carried out with appropriate quality standards, which should now be defined.
