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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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Reimbursement of telemedicine and digital care in the Netherlands

Digitization is playing an increasingly important role in the organization of healthcare. Under digital care, Dutch Healthcare Authority (NZa) considers the application of both digital information and digital communication to support and / or improve healthcare. The same definition is applicable to the term e-health implemented by the Centre of expertise for standardization and eHealth (Nictiz).

The following classification of digital care was developed by the Council for Public Health and Society:

  • E-care: e-diagnosis, e-consultations, e-care such as monitoring, e-prevention intervention at high risk in an individual;
  • E-support: e-access to patient records, e-management such as making appointments online;
  • E-public health: e-health education, e-prevention such as detecting certain risk groups.

Only digital care that meets the so-called 'package criteria' may be declared by care providers under the Health Insurance Act (Zvw) and Long-term Care Act (Wlz). The main criterion is that care must be safe and proven to be effective. The Zvw describes which medical devices (such as e-health technology) are eligible for reimbursement from the basic package. Certain medical aids are part of the specialist medical care and are charged to the hospital (via DRG). Others fall under medical device care and are reimbursed separately by the health insurer.

In 2021, the 'Telephone Consultation' performance will be replaced by the new ‘Triage consultation' service: a distinction will be made between the first contact (the triage) and the possible follow-up (consultation or visit). The consultation can take place at the GP office, the patient's home, or in digital form (via video call, for example). The existing 'Telephone consultation' performance may be used for this purpose up to December 31, 2020. Since 2021, the new 'Triage consultation' performance (in which the method of delivery no longer matters) can be declared by the GP.

Instead of an outpatient consultation, a healthcare provider can do the consultation remotely. A first outpatient visit, which is carried out by telephone or in writing, may temporarily be registered as a regular first outpatient visit. It is already permitted to register a screen-to-screen consultation as the first consultation.

Reimbursement for home care technologies has been broadened and simplified since 2020. In 2019, the care provider can claim a maximum of 4 hours of screen communication and a maximum of 2.5 hours of remote pharmaceutical care per patient per month at the agreed hourly tariff for nursing and personal care services. Since 2020, for a patient who receives the home care technology, a maximum of 6.5 hours per month can be declared at a maximum agreed tariff for nursing and / or personal care. Direct contact time required with home care technology can be declared through regular services. This extra compensation is possible in addition to the hours for direct contact time in the case of video calling with a patient.

In 2020, speech therapy will have a specific temporary performance for digital care called telelogopedy, when it is permitted to physically see a patient at least once at the beginning of a treatment course. Since 2021, this performance will expire, and there will be no restrictions for declaring digital care for speech therapy.

The full details in Dutch can be found here.

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