Impact of reimbursement policies on the adoption of medical devices in an outpatient setting

• Advances in medical device technology can facilitate treatment in an out-patient setting.
• DRG payment systems are slow to adopt enabling technologies and local arrangements fragmented.
• Outpatient DRG fee levels do not that encourage take up of innovative technologies.
• Outpatient payment codes are only suitable for fast, high volume, low cost procedures.
• Cost-effectiveness evidence should be sent directly to the authorities that create new DRG codes.

ObjectivesTo consider how reimbursement systems in the UK, Germany, Italy, France and Spain affect adoption of medical devices that facilitate care in an ambulatory setting.MethodsExamples of technologies that could be used in an outpatient setting but are predominantly used on inpatients were identified. Hospital payment systems were explored and the implications of funding policies for the adoption of medical devices in an outpatient setting considered.ResultsAlthough many countries attempt to develop ambulatory care payments, their DRG/HRG systems introduce a time lag for the uptake of new treatments and do not routinely identify and adopt enabling technologies. Arrangements to fund new technologies are often localised and inconsistent which can result in missed opportunities for savings. There are fewer reimbursement codes for outpatient procedures and this appears to present a barrier to the take-up of new technologies that reduce inpatient bed days. Current levels of outpatient fees are suited to fast, high volume, low cost procedures.ConclusionsThis review identifies attempts to improve coding tariffs, increase the frequency of updates and introduce more out-patient DRG codes. Healthcare payers need to be satisfied that new technologies are cost effective before they agree funding outside DRG based fee systems and the negotiation process would be more efficient if payers pooled expertise for reviewing cost-effectiveness evidence and fed conclusions directly to tariff setting authorities. New DRG codes and higher outpatient tariffs for cost effective technologies that enable a switch to ambulatory care could incentivise hospitals to revise care pathways.