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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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2022/23 NHS priorities and operational planning guidance in England

03 May 2022

On April 12, 2022, NHS England and NHS Improvement (NHSE/I) published 2022/23 priorities and operational planning guidance, with three supporting documents:

  • Elective recovery planning supporting guidance;
  • Capital guidance for 2022-25;
  • Revenue finance and contracting guidance.

Elective recovery plan key objectives include the following: expand capacity to reduce waiting times, prioritize treatment based on clinical urgency, move the location of elective care services to drive productivity (e.g., through community diagnostic centers, surgical hubs, and improved patient pathways).

Several ambitions are defined, including reducing waiting times for diagnostic tests (95% of patients receive them within six weeks) and cancer diagnosis (75% of patients referred for suspected cancer are diagnosed or have cancer ruled out within 28 days).

The following funding is available for elective recovery over 2022/23:

  • £1.5 billion of capital above that funded within core envelopes has been made available to the NHS over three years to support new surgical hubs, increased bed capacity, and equipment to help elective services recover;
  • £2.3 billion to transform diagnostic services, including at least 100 community diagnostic centers across England, to permanently increase diagnostic capacity.

Capital guidance defines the scope of capital envelopes for three years (2022 to 2025). The scope was updated to include primary care capital and indicative funding allocations for diagnostic, digital, and elective recovery capital. The system operational capital envelopes for 2022/23 will include the replacement of diagnostic (e.g., CT and MRI machines) and radiotherapy equipment.

For 2022/23, the NHS capital allocation will be split into three categories:

  • A system-level allocation (£4.1 billion) to cover day-to-day operational investments, which have typically been self-financed by organizations in integrated care systems (ICS) or financed by the Department of Health and Social Care (DHSC). From 2022/23 onwards, this includes a £0.1 billion investment in primary care estates and IT. In 2021/22, this was £3.9 billion (excluding primary care);
  • Nationally allocated funds (£1.1 billion) to cover nationally strategic projects already announced and in development or construction, such as hospital upgrades and new hospitals. In 2021/22, this was £1.2 billion;
  • Other national capital investment (£2.7 billion), including national programs such as elective recovery, diagnostics, and national technology funding. In 2021/22, this was £1.7 billion.

According to revenue finance and contracting guidance, from 2022/23, all national High Cost Tariff Excluded Devices (HCTED) funding will be managed on a national basis, outside baseline contracts between commissioners and providers. The national finance team will manage the monthly transactional process and reimburse trusts directly.

Revenue finance and contracting guidance also provide details on technology funding. ICSs will need to agree on how technology funding is to be allocated between their partners. However, the existing funding flows and mechanisms will remain - capital funding will flow from the DHSC to trusts, and revenue funding will flow to ICBs, which will then be able to pass it to trusts and other organizations.

See the full details on elective recovery planning supporting guidance here, capital guidance for 2022-25 here, and revenue finance and contracting guidance here.

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