Reimbursement

On April 8, DRG tariffs for 2022 were published in the Official Journal of the French Republic and on the website of the Agency for Technical Hospital Information.

The revised EBM (German Uniform Evaluation Standard) catalog came into force on April 1, 2022. The most significant changes concern the introduction of new additional flat rates for the observation and care of patients who are given certain medications, adjustment of EBM reproductive medicine definitions, and inclusion of several new codes for PET and PET/CT.

On March 31, 2022, NHS Digital released HRG4+ Local Payment Grouper for 2022/23 for use from April 01, 2022. In general, there are significant changes in base HRG design. A total of 120 new HRGs were created, and multiple HRGs were removed, so the total number increased by 62 from 2,838 to 2,900.

On March 10, 2022, santésuisse announced that the Swiss Federal Department of Home Affairs (FDHA) had decided to reduce the tariffs for laboratory tests, which is a consequence of santésuisse's repeated call for price reductions in the previous years. Santésuisse expects the price reduction to be substantial and to enter into force soon.

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in March 2022. More than 15 recommendations were published in relation to the registration, modification of registration conditions, and renewal of registration for devices in the List of reimbursable products and services (LPPR). Opinions concern cardiovascular and peripheral vascular, orthopedic, and neurovascular devices, as well as medical aids.

On March 23, 2022, the Norwegian Directorate of e-Health released an updated version of the National Laboratory code (NLK) system (Norsk laboratoriekodeverk 7280.62) to be implemented no later than May 01, 2022. Thirty-two codes were added, 91 codes have been changed, and one code has been terminated. NLK system has been used for activity-based reimbursement by the Norwegian Health Economics Administration (Helfo) in outpatient settings since 2018.

On March 24, 2022, the entity developing the new outpatient lump-sum reimbursement system (Solutions Tarifaires Suisses AG, STS) announced that they are currently working on updating the system, which will be open for consultation again at the end of 2022 and then submitted to the Federal Council for final approval. The introduction of the new reimbursement system is expected in 2024.

On March 31, 2022, NHS England and NHS Improvement (NHSE/I) released the 2022/23 National Tariff Payment System (NTPS) to come into force on April 01, 2022. The aligned payment and incentive (API) model remains the central part of the 2022/23 NTPS, covering all secondary healthcare services, with few exceptions (e.g., diagnostic imaging, the contract value is lower than £30 million). National DRG (HRG) tariffs only remain for diagnostic imaging; other tariffs are published for benchmark purposes. Four new device categories were included, and two existing categories were updated to cover more devices in the 2022/23 High Cost Device List; In 2022/23, all High Cost devices are excluded from the fixed element and funded on a cost and volume basis.

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in February 2022. More than 25 recommendations were published in relation to the registration, modification of registration conditions, and renewal of registration of devices in the List of reimbursable products and services (LPPR). Opinions concern cardiovascular and peripheral vascular, orthopedic, neurovascular, and neuromodulation devices, as well as breast implants and medical aids. Except for this, CNEDiMTS published two negative opinions concerning transitional coverage of devices.

On March 17, 2022, the French National Authority for Health (HAS) published a standard for telemonitoring of patients with implantable cardiac devices (implantable defibrillators and pacemakers). In January 2022, the HAS also published standards for medical telemonitoring of four chronic pathologies (chronic respiratory failure, chronic heart failure, chronic renal failure, and diabetes). All these standards must be met by technologies in order to be reimbursed by the new reimbursement framework for telemonitoring, which is expected to enter into force in July 2022.

On March 03, 2022, NHS England and NHS Improvement published a research demand signaling document for the National Stroke Programme. This document highlights the priority areas for research to inform national policy and support the NHS Long Term Plan targets. One of the high-priority areas is the technology for diagnosis, including artificial Intelligence solutions, innovative triage tools, technologies for the early and accurate diagnosis/detection of stroke.

In March 2022, NHS England opened a call for applications to the High Cost Device List (HCDL) changes for the 2023/24 National Tariff Payment System. The completed application form should be submitted via email by May 31, 2022. HCDL items are then either included in a fixed payment or paid in addition to the price of the related service.