Video consultation in the practice

As a consequence of the ongoing covid pandemic and the resulting changes in psychotherapy, there is an increased demand for online therapy sessions. The need for these video consultations stems primarily from the fact that corona-related circumstances such as hygiene and distance regulations and the mask requirement determine the daily therapeutic routine. Whereas at the beginning of the pandemic video therapy was still improvised in many places and new in its implementation, at the present time more experience with the form of treatment can be mapped. Due to the ongoing pandemic as well as the flexibility resulting from videotherapy, it is obvious that it will continue to play an important role in therapy in the future. 

The following is intended to provide you with an overview of what you need to know and consider as a psychotherapist:in the context of conducting video consultations.

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What are the conditions for conducting a video consultation in psychotherapy?

In principle, every psychotherapeutic session can be conducted as a video consultation, provided that an initial personal contact including information, initial diagnostics and indication has already taken place. This means that the psychotherapeutic consultation and probationary sessions must take place in personal contact. This regulation was temporarily suspended due to the Corona pandemic and has been in force again since April 01, 2022. 

Even after the initial contact, there is still the recommendation of face-to-face contact in psychotherapy. With this in mind, the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung) and the health insurance funds have agreed to limit the quota of services performed by video. An upper limit of 30% was set. In order to give psychotherapists more room for maneuver, it no longer matters which sessions are performed online after the consultation hour and probationary period as of July 1, 2022. The main thing is that no more than 30% of all services take place online. 

Of course, the professional regulations of the respective state chamber for initial contacts must still be followed.

It is important in all respects to observe the professional code of conduct including the duty of care, just as in conventional psychotherapy.

Since the end of 2021, it has also been possible to conduct group therapy as video therapy. A maximum of eight patients are permitted in a group therapy session. The psychotherapist must conduct the session alone from the therapeutic side. 

It is also possible, by informally notifying the health insurance company, to conduct group sessions of 100 minutes each, which have already been approved, online as individual therapy sessions of 50 minutes each. 

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What technical requirements do I need to consider?

Provisions on information technology security stipulate that the transmission of the video consultation should take place without the use of a central server. If this is deviated from, it is the responsibility of the video service provider to ensure an appropriate level of data protection and security. The exact technical requirements for conducting videotherapy can be found in Annex 31b to the Bundesmantelvertrag-Ärzte (BMV-Ä). 

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What are the criteria for choosing a video service provider?

The video service provider used for videotherapy must be certified. For this certification, the provider must submit a self-disclosure in advance to the National Association of Statutory Health Insurance Physicians and the Central Association of Statutory Health Insurance. Once the contract has been concluded, the practice should then obtain a certificate from the video service provider disclosing that it meets the requirements for IT security and data protection. For example, the video service provider must guarantee that the content of the video consultation is encrypted end-to-end during the entire transmission process, that data is not viewed, stored or passed on, or that metadata must be deleted after three months at the latest. Also, the video service provider must not have any serious security risks. A list with an overview of certified providers can be downloaded from the website of the National Association of Statutory Health Insurance Physicians (KBV). However, this is only for orientation purposes, as the actual certification is carried out by independent bodies. 

It is important for psychotherapists to know that they can only bill for video consultation services if they have reported in advance to their Association of Statutory Health Insurance Physicians about the certification of the service provider. Although this regulation is currently suspended in some KV regions due to the pandemic, it should be kept in mind.

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What applies when it comes to data protection?

For provisions on data protection , the legal framework for the processing of personal patient data must be observed by both the video service provider and the psychotherapist. The underlying content is drawn from the Basic Data Protection Regulation (DSGVO), the Federal Data Protection Act (BDSG), the Fifth Social Code (SGB V) and the Tenth Social Code (SGB X). In this regard, the video service provider is obliged to comply with the DSGVO. It is also important that the processing of personal data may only take place in Germany or in a member state of the European Union. Only on the basis of special conditions may the processing of data also take place in an equivalent state or a third country. 

What are the requirements for psychotherapists?

With regard to the security of data processing, psychotherapists are responsible for ensuring the necessary information technology and data protection measures within their own premises and IT systems. This also includes the selection of a certified service provider. 

Psychotherapists must also provide adequate technical equipment, which usually includes a screen, a camera, a microphone and a loudspeaker. Patients must confirm the voluntary nature of their participation and give their consent to the data processing of the video service provider used. From both sides, the undisturbed course of the treatment should be ensured by holding the session in a closed room, which, just like in a conventional session, guarantees the necessary privacy.

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What do I need to know about compensation?

Payment for video consultations is based on the respective flat rate for the insured, the basic flat rate or the consultation flat rate. The flat rates including surcharges are paid in full if there is personal contact with the patient in the same quarter. If, on the other hand, there is no personal contact between the therapist and the patient, the flat rates and supplements are reduced. This reduction is made according to the specialist group and as a percentage of the respective flat rate or supplement. Psychotherapists fall into group 1, for which a reduction of 20% is provided.

Practices also receive a technology allowance to fund the cost of the video service per video consultation performed and can bill for services for conversations that occur via video consultation. There is also a surcharge for the expense of authenticating new patient:s within a video therapy session.

Another change under the pandemic is that the maximum number of treatment cases allowed to be treated exclusively by videotherapy is no longer 20%. In addition, the amount of services that may be performed as part of video therapy is no longer 20%.

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In summary, what is the process of videotherapy?

1. The psychotherapist registers with a certified video service provider. The provider provides the patient with additional information, such as free times reported by the practice for the video consultation and how to register for a video consultation.

1. The patient receives an appointment for a video consultation, either through the practice or through the video service provider.
2. The patient gives his/her consent before the first video consultation, again either via the video service provider or directly via the practice.
3. Patient and psychotherapist dial in to the video service provider. Patients may have to wait in the online waiting room until they are called by the psychotherapist.
4. Both parties introduce themselves at the start of the consultation. The identity of the patient must be clearly recognizable to the practice. If it is the first consultation, the electronic version of the health card must be shown to the camera at the beginning of the session so that an identity check and recording of all necessary data can take place. Verbally, patients must also provide information about their existing insurance coverage. Recordings are only permitted during the video consultation with prior consent, and the video consultation must not contain any advertising. 
5. At the end of the video consultation, both participants log off from the website. The psychotherapist then documents the treatment in the practice management system.