Potential assessment will be re-regulated from July

Berlin. The Federal Joint Committee (G-BA) has once again approved an exception to the assessment of potential for out-of-hospital intensive care (AKI). Unlike the previous special regulations, this exception will now apply permanently: For insured persons who received AKI services up to and including June 30, 2025, a potential assessment is not mandatory.

According to a statement from the Federal Committee on Wednesday, the assessment of potential for these existing cases will only be carried out if there are indications of potential for weaning or decannulation, or at the request of the affected person. "Follow-up prescriptions for outpatient intensive care will be possible for up to twelve months for this group of insured persons," it continues.

Not enough capacity

Dr. Bernhard van Treeck, an impartial member of the Federal Joint Committee (G-BA) and chairman of the Subcommittee on Incurred Services, described the new resolution as a "pragmatic exception." On the one hand, it ensures the patient protection intended by the legislature. On the other hand, it helps to use the limited medical capacity for potential assessments "primarily for those patients who are expected to have the greatest potential for withdrawal."

Van Treeck: “Especially in cases of chronic, progressive diseases or irreversible damage, the potential for withdrawal usually decreases over time, unfortunately.”

Mandatory for new cases

However, the general requirements apply to all patients who receive outpatient intensive care for the first time from July 1 or later and who are ventilated or have a tracheostomy tube. Specifically, they require a potential assessment before each prescription. Physicians must therefore check whether the weaning potential has been assessed or needs to be assessed and must arrange for this accordingly.

According to a statement from the KBV, the potential assessment must be conducted at least every six months and must not be older than three months at the time of prescription. If the potential assessment determines that there is no prospect of sustained improvement in the underlying functional disorder and that decannulation or weaning is not permanently possible, the assessment only needs to be conducted every twelve months and must not be older than six months at the time of prescription.

If it is then determined that there is no prospect of improvement in at least two directly conducted personal potential assessments for two consecutive years, further assessments can be dispensed with entirely.

The current special regulation for potential assessment will expire at the end of June. (juk)