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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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German Ministry of Health released “starting catalog” with initial services to be reimbursed via Hybrid DRGs

The so-called hybrid DRGs reimbursement mechanism will first cover services from the “starting catalog”, and it will be implemented at the beginning of 2024. The catalog itself is still not publicly available.

The starting catalog includes certain hernia procedures, the removal of ureteral stones, ovariectomies, arthrodeses of the toe joints, and treatments for a pilonidal sinus (coccygeal fistula).

These services should be reimbursed using one of the hybrid DRGs listed as an appendix to the regulation - provided that the case is grouped into the relevant hybrid DRG. To ensure this allocation, data processing solutions certified by the Institute for the Hospital Remuneration System (InEK) should be used. The algorithm considers additional conditions, such as the length of stay and the level of clinical complexity. Patients with complex procedures that can only be performed in inpatient settings and with complex diagnoses, such as malignant neoplasms, would be excluded as hybrid DRGs by the algorithm.

According to the draft regulation, the hybrid DRGs would be billable for the entire duration of the services provided. The start of the services is defined as the point in time when the preparation and planning for the surgery are initiated. The completion of the postoperative follow-up would be considered the end of the provision of the services.

The draft also stipulates that the hybrid DRGs cover all services and expenses related to the treatment of the patient. This applies to the necessary material resources, the costs of accommodation and food for the patient in the case of an overnight stay, as well as necessary laboratory and X-ray services.

The reimbursement mechanism of hybrid DRGs should incentivize the provision of services within outpatient settings (as the costs are lower, but the tariff is the same). The introduction is expected in January 2024.

The full details in German can be found here.

This news is just one of about 300 market access news collected by our team in the subscription services "HTA Alerts" and "Reimbursement Alerts" every two weeks from more than 80 organizations. Access our paid subscription services to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Contact us to get a free, three-month, no-obligation trial.