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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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The new tariff structure for the Swiss ambulatory setting submitted to the Federal Council

As MTRC described in January 2019, The outpatient medical services are currently billed via TARMED, which includes all the benefits of compulsory health insurance. TARMED is an outdated structure; Thus, curafutura, an association of health insurance companies in Switzerland, started the initiative to change the current outpatient pricing structure (TARMED) in 2016.

Ats-tms SA was founded at the beginning of 2016 by curafutura, the Federation of Swiss physicians (FMH), the association of Swiss hospitals (H+, who left ats-tms SA after the validation of benefit structure) and the medical tariff commission (MTK/CTM) in order to develop a thoroughly revised tariff structure for ambulatory medical benefits and to be able to update it regularly.

On July 12, 2019, the Swiss Medical Tariff Commission (MTK/CTM), announced that the new tariff structure for the ambulatory sector, TARDOC, is ready to replace TARMED. The Medical Professional Association (FMH) and curafutura, the other involved partners, delivered TARDOC to the Federal Council for approval.

The new structure represents the services provided as an outpatient procedure and includes about 2800 positions spread over 70 chapters and divided according to the regions of the body. It is already available to the public and can be seen here.

FMH and curafutura recognize the principle of cost neutrality pursuant to Article 59c, point 1, letter C of the Health Insurance Ordinance (KVV/OAMal). However, service providers and insurers have different ideas on how to implement the transition from TARMED to TARDOC in compliance with this principle. Therefore, two variants have been presented that are distinguished only by the number of tariff points.

The TARDOC structure is expected to enter into force on January 1, 2021.

See the communication posted by the MTK/CTM here in Italian (change to French or German in the top right corner) here.

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