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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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InEK opened DRG proposal procedure for 2019 in Germany

The German diagnosis-related group (DRG) system is maintained and updated by the Institute for the Hospital Remuneration System (InEK). Every year, the InEK invites stakeholders of the German healthcare system to contribute with medical and scientific expertise to the development of the DRG system. Typical applicants for DRG system changes include hospitals, Medical Societies and the German Medical Technology Association (BVMed). Suggestions that affect several Major Diagnostic Categories (MDC) should be aligned with the relevant Medical Societies before submission.

Proposals can be submitted via a web portal provided by InEK from December 1st, 2017 until March 31st, 2018. Following suggestions for changes in the DRG system for 2019 can are possible:

  • Add-on payment (Zusatzentgelt, ZE)
  • Development of DRG system (including regrouping or split/creation of DRGs)
  • Coding guidelines
  • Complication and Comorbidity Level (CCL) matrix
  • Cost calculation
  • Others

Particularly the possibility to apply for add-on payments (ZE) is important for hospitals to improve funding for insufficiently reimbursed procedures. ZE is paid in addition to the DRG flat rates and is applicable for procedures that are significantly more costly than other procedures within the relevant DRG (cost outliers) but don’t qualify for separate DRGs. The amount of add-on payments are negotiated between hospitals and Sickness Funds. Manufacturers can support hospitals in this process by providing relevant information, such as procedure descriptions or statistics. The name of the applicants and short descriptions of the content of the applications are published on InEK‘s website.

The application process is described in detail in a document provided by InEK. Further, a manual for the use of the online portal is available on InEK‘s website.

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