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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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2019/20 national tariff published

The 2019/20 national tariff payment system has now been published and will take effect on the 1st of April 2019. There have been no substantial changes to the proposed tariff consulted on during January and February 2019.

The following main changes were made:

  • For 2019/20 it has been introduced a blended payment for emergency care. A number of BPTs relate in part or in whole to emergency care. These BPTs should be used to determine the prices paid for emergency care
  • Urgent and emergency care services were removed from the scope of national prices, and the marginal rate emergency tariff (MRET) and 30-day readmission penalties were dismissed. Providers and commissioners will be expected to implement the new blended payment system unless they have “already moved on” to more integrated alternatives. This approach will only be available for providers and commissioners where the expected contract value is £10m or more, with specialized services and nonacute care not included in the scope
  • A blended payment system will become the default for adult mental health services. The system would mix a fixed or block element, an element based on the activity “clusters” that have been trialed in recent years, and an element based on outcomes
  • Revise of Market Forces Factor (MFF). It has been reviewed and updated the method and data used to calculate MFF values for the first time since 2010/11. The review of the MFF also produced a framework for assessing if a particular category of the unavoidable cost would be appropriately addressed by the MFF
  • All maternity prices will become non-mandatory. This is to address a specific issue relating to the pricing of public health services and making further changes to the maternity pathway payment system
  • Prices updated
  • High-Cost Device List updated

Documents with details of the tariff prices and rules and guidance on implementing them can be found here.

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