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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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Requirements for chronic back pain disease management program outlined in Germany

Statutory health insured patients with chronic back pain can benefit in the future from a structured treatment program (Disease Management Program, DMP): The Federal Joint Committee (G-BA) outlined on the 18th of April the substantive requirements for the new DMP. These include, for example, the eligibility criteria, the individual treatment planning, and the coordination of the different specialists involved in the treatment process within the therapeutic approach. The statutory health insurance funds can conclude contracts with physicians and / or hospitals for the practical implementation of the DMP after the decision has come into force.

Enrollment in the DMP will be possible for the patients with chronic (more than 12 weeks) pain in the cross-sectional area of the back, significant activity restrictions, and lingering needs in treatment. If there are specific causes for the back pain, such as vertebral fractures, rheumatic diseases or a tumor in the spinal column area, enrolment in the DMP will not be possible, as the treatment of the causative disease(s) is in the foreground. The attending physician will be obliged to check whether the inclusion and exclusion criteria for enrollment in the chronic back pain DMP are met.

The individually indicated therapeutic measures will be planned during the doctor-patient interview - pain intensity and activity restriction of the patient as well as the successes achieved in the course of treatment are to be considered here. It is obligatory for every patient enrolled in the DMP to be informed about the decisive, positive role of physical activity and to be motivated to undergo physical training. The chronic back pain DMP also will include basic and drug-related recommendations for pain medications.

The scientific basis of the new DMP is built with the use of the information presented in “Systematic guideline search and evaluation as well as extraction of relevant recommendations for a chronic back pain DMP” of the Institute for Quality and Efficiency in Health Care (IQWiG), published in November 2015. IQWiG was assigned this task by the G-BA in August 2014.

The G-BA is now submitting the resolution to the Federal Ministry of Health (BMG) for examination. After non-objection, the requirements for the chronic back pain DMP and the corresponding documentation will come into force on the first day of the quarter following the publication in the Federal Gazette.

The DMP requirements for the following chronic diseases are also currently being developed:

  • Depression
  • Osteoporosis
  • Rheumatoid arthritis

The full details in German can be found here.

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