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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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Updates related to EBM catalogue in Germany

The fee negotiations for the coming year are over - the National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) agreed on an increase in the monetary conversion factor for all medical and psychotherapeutic services in the amount of 1.52 percent.

From the coming year, the monetary conversion factor is 10.9871 cents (currently it amounts to 10.8226 cents). The increase corresponds to a rise in fees of around 565 million euros. The monetary conversion factor determines the prices of the medical and psychotherapeutic services and is renegotiated every year.

GKV-Spitzenverband and KBV have also agreed to sponsor the video consultations. From 1 October 2019, the statutory health insurance companies will pay start-up funding for doctors who conduct video consultation sessions up to €500 per doctor and quarter. The funding opportunity is valid for two years and takes place as a surcharge on the fee order item (GOP) 01451 (rating: 92 points / €9.95). Further adjustments in terms of promotion of the video consultations are planned to be agreed by the Evaluation Committee by the end of September.

Beginning from the next year, in the field of human genetics, the medical assessment services and consulting services (GOP 01841, 11230, 11233 to 11236) will be excluded from the morbidity-based overall remuneration (morbiditätsbedingen Gesamtvergütung, MGV) and reimbursed extrabudgetary - initially for three years. The background is the volume growth in this area.

GKV-Spitzenverband and KBV also agreed that existing extrabudgetary remuneration for in-vitro diagnostic of tumor genetic alterations (EBM Section 19.4.2) would be provided outside MGV until July 1, 2023. Thus, the evaluation committee takes into account the growing importance of genetic diagnostics and counseling. This benefit in particular patients with rare diseases and malignant neoplasms.

The regional change rates in morbidity and demographics were decided by KBV and GKV-Spitzenverband in the first round of fee negotiations on the 14th of August. Together with the monetary conversion factor, they form the basis for the regional remuneration negotiations, which begin in the autumn.

The full details in German can be found here.

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