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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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SwissDRG considers creation of a national agency for ambulatory tariffs

At the moment, the entity that manages the outpatient tariff system in Switzerland is TARMED SA. However, the entity that runs and manages the Swiss DRG system, SwissDRG SA, checked the necessary conditions for the creation of a new outpatient tariff agency. The representatives of santésuisse, the medical tariff commission (MTK/CTM), the Swiss Conference of Cantonal Health Directors, the Swiss Hospital Association (H+) and the Swiss Physicians’ Association (FMH) clearly show their support for a tariff partnership and wish to expand it into management of outpatient medical services under the auspices of SwissDRG SA. Preliminary work on the feasibility of outpatient packages has demonstrated the technical feasibility. However, various framework conditions need to be clarified beforehand.

You can find the full communication to the public in French here.

SwissDRG has also published their feasibility study, which can be found in German (with summary in French) here.

This feasibility study has demonstrated that outpatient packages can be evaluated based on cost and benefit data. Due to the availability of these data per case, it is possible to quickly establish ambulatory packages. In the current tariff environment, unwanted scenarios occur due to the different pricing of ambulatory and stationary benefits. The bundling of benefits and the clear primacy of the outpatient over the inpatient reduces the unwanted incentives in the system.

The publication presents many aspects (e.g. incentives, the need for an update of the outpatient system, inconsistent financing of the outpatient and inpatient services, perspective of the payers,  etc.), but also provides the examples of how SwissDRG would develop new outpatient lump sums based on the SwissDRG tariff structure.

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