Reimbursement analysis is performed to understand the current market access situation for medical technology.
This includes the availability of procedure/reimbursement codes, understanding the payment mechanism and reimbursement tariffs, as well as policy (coverage) and HTA considerations.
Since reimbursement analysis is always a starting point for medical device companies, an analysis thereof helps to establish whether technology is reimbursed or not. If it is reimbursed, is this tariff sufficient? Are there any restrictions for the use of the product? All these factors are considered as part of the reimbursement analysis process.
Once the reimbursement situation is clear, we work on a reimbursement strategy to determine how to establish or improve the reimbursement and general market access situation for medical technology.
What is included
in the scope?
MTRC is the leader in reimbursement analysis for medical technologies in Europe. We provide services to most of the major corporations, numerous small- and medium-sized enterprises, as well as other life sciences consulting companies. Over many years of practice, MTRC has developed a robust analytical and reporting methodology that answers all your key questions.
The typical scope of the project includes:
Availability of procedure / reimbursement code
Reimbursement mechanism (diagnosis-related group or fee for service)
Availability of add-on reimbursement
Availability of innovation funding
Statements from national commissioners (e.g., NHS England)
Health Benefit Catalogues (e.g. in Spain, LEA Levels in Italy)
National clinical guidance (e.g. NICE in the UK, Haute Autorité de Santé in France, Socialstyrelsen in Sweden)
National health technology assessments in connection with reimbursement decisions (e.g. NICE for Technology Appraisal in the UK, Haute Autorité de Santé in France)
Specific funding frameworks (e.g., “New method” in Norway)
Technological coverage of our services
We provide services for major types of medical technologies:
Our team has worked on hundreds of reimbursement/HEOR projects within different clinical and technological areas, including heart valve replacement, minimally invasive and open heart surgery, coronary, cerebral and peripheral stenting, coronary diagnostic and imaging techniques (fractional flow reserve, intravascular ultrasound), coronary, cerebral and peripheral vascular thrombectomy, implantable and extracorporeal ventricular assist devices, clinic- and home-based dialysis, extracorporeal membrane oxygenation, apheresis, obesity surgery, hernia and reconstruction surgery, tissue products and skin reconstruction surgery, negative wound pressure therapy and medical bandages, neurostimulators for different indications, cell therapy, rehabilitation devices, devices for minimally invasive and open spine surgery, embolization procedures, glucose monitoring, use of fusidial markers, radiotherapy, and endoscopy, amongst others.
How does the analysis work?
A typical project includes several steps:
This includes specifics of the technology and procedure (mechanism of action, surgical access, duration of procedure, imaging required, pre- and post-procedure requirements, length of hospital and Intensive Care Unit stay, cost of device/procedure), and specifics of analysis (e.g., characteristics of patients, the necessity of day case or admitted hospital analysis)
Procedure coding is important as it defines payment mechanism and tariffs in any healthcare system. Our teams use official nomenclatures and coding manuals from coding/reimbursement authorities. Where possible, the findings are validated with other sources
This is another crucial step in the analysis. Payment model can vary significantly and can include reimbursement via Diagnosis-Related Groups (DRG) add-on reimbursement, innovation funding, unbundled (top-up DRGs), fixed payment for procedures, amongst others
Once the payment mechanism is clear, it is possible to define reimbursement tariffs. Both national and regional systems are analysed, where relevant (e.g., in Finland and Italy)
Reimbursement works hand in hand with funding and advisory frameworks in individual countries. For example, Diagnosis-Related Groups (DRG) and a good tariff can be in place, but authorities restrict the use of the method to a certain population. MTRC analyses the necessary policy frameworks, clinical guidelines by governmental bodies, and health technology assessments
Our teams always propose a free-of-charge teleconference to discuss the findings of reimbursement analysis, since results in multiple countries could be very complex and hard to understand. We offer the interpretation and inform the client about the existence of reimbursement barriers in particular countries
The next step would be to work on reimbursement strategy in the situations where payment, coverage, or HTA barriers have been identified for technology in individual markets
Geography of our projects
MTRC is a provider of multi-country European projects. We have worked on the projects in 34 European countries
MTRC in numbers
An extremely specialised boutique consultancy with a global impact
Our timelines support your timelines
The analysis is delivered timely to inform your business decisions.
The typical timelines in our proposals are five to eight weeks long, depending on the workload of the team. We always deliver projects on time or ahead of schedule.
It is also possible to expedite the project (subject to price adjustment) to mere days or one to two weeks.
How does MTRC perform the analysis and ensure high quality of work?
In order to deliver analysis in multiple and very diverse EU markets, we employ a number of approaches:
We secure access to necessary coding/grouping software and documentation.
In many countries, the software for DRG analysis is only available at a significant cost or available only to hospital providers. We make sure that necessary tools are at our disposal for analysis
We developed know-how of reimbursement analysis in EU markets over many years of consulting practice.
While there are certain general patterns of analysis, which are the same for any system, each country is unique, and a true understanding of the market comes only with the experience
We became a highly standardized organization to ensure the high quality of our work.
We maintain Work Instructions in every country to train new analysts, checklists for daily work, necessary processes, and meetings to learn from mistakes and share knowledge within the organization. We are an ISO 9001:2015 certified organization (with the United Kingdom Accreditation Service, UKAS), which confirms the existence of well-structured processes of quality management
We stay up to date about developments in key markets through our unique paid subscription services Reimbursement and HTA Alerts
We are usually the first to learn about new developments, including procedure coding, payment mechanisms, policies, HTA landscape in general and in relation to individual technologies. We monitor more than 50 organizations every two weeks and more than 200 organizations annually to have a good understanding of all changes in the payment systems
All reports are reviewed by the Director
Being a small, boutique consultancy, we can ensure that our senior leadership expertise is available to every client
Get in touch
Contact us to discuss your needs and learn about our services