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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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Dutch Healthcare Authority published key features of the DRG package for 2021 (RZ21a)

Dutch Healthcare Authority (NZa) has released key features of the DRG package for 2021. The changes are based on requests from the health care providers, health insurers, and the industry parties submitted by NZa.

The key changes include:

  • Adjustments stem cell transplant care, including distinction in the DBC (Dutch version of DRG) care products for adults and children;
  • Medical specialist with so-called “gate function” are given more room per 2021 to register the consultations, including care activity “Repeat consultation by (medical) representative of a patient for whom personal presence means too great a disruption of daily functioning and well-being” (190065) and care activity “Analysis of treatment advice and / or treatment prepared and / or performed elsewhere, within the framework of a second opinion” (190022);
  • Adjustment of the position on MammaPrint (in RZ20b): the assessment of MammaPrint by the Dutch Health Institute (ZIN) was considered in the RZ20b. However, this interpretation has a nuance: “Due to the widespread (confidence intervals) of the study results, there is great uncertainty regarding the survival data. Because of this uncertainty, ZIN does not make a statement about the application of MammaPrint in practice. The clinical utility of the MammaPrint cannot be determined based on the current data. As a result, MammaPrint does not meet the state of science and practice, and the MammaPrint cannot be reimbursed under the basic package”;
  • The DRG tariffs for 2021 are indexed. An exception is made for a number of DBC care product groups that are reviewed based on the cost prices from 2018, including geriatric rehabilitation care, pediatrics and neonatology, stem cell transplantation, and dental surgery.

The schedule with the most important milestones for the DRG package 2020 can be found here.

See the full details here.

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