Reimbursement/DRG analysis

Reimbursement analysis is essential to understand openness and attractiveness of the market for your technology. Incorrect understanding of reimbursement landscape for technology can postpone market access for years.

Synergus offers best-in-class service of reviewing current reimbursement landscape to drive business strategy.

In the analysis we will typically answer the following questions:

  • What is the mechanism of reimbursement of technology?
  • What are reimbursement tariffs?
  • Are there any conditions for reimbursement?
  • What is the pathway to initiate change?
  • What is the strategy and time line for your technology?

Mechanisms of reimbursement vary greatly depending on the type of technology and clinical settings. Majority of European countries have implemented diagnosis-related group (DRG) payment for in-patient procedures. Several countries have implemented add-on DRG top up payments for expensive technologies, including medical devices. There are other mechanisms of payment in place (global budget, fixed budget or even fee-for-service) for in-patient procedures.

In out-patient settings payment mechanisms vary from DRG to fee-for-service in most of other European countries. In-vitro diagnostic tests are usually reimbursed via specific mechanisms using fee-for-service principle in out-patient setting.

The next step in the analysis in obtaining reimbursement tariffs. For every project we develop number of clinical scenarios for considerations, which include different indications, use of technology as stand-along procedure or as adjunctive to another one, settings of care (in-patient vs out-patient). Results are provided in a nice overview format to enable snapshot overview of reimbursement tariffs.

Finally, conditions for reimbursement are being analyzed. It may include limiting use of technology to:

  • specific indication (e.g. drug-eluting stents are only can be used in diabetic patients)
  • method of use of technology (e.g. mandatory test procedure for spinal nerve stimulator)
  • evidence (e.g. requirements for controlled study with specified comparator for every new device)
  • number of patients (e.g. only 100 liver dialysis procedures are reimbursed annually)

Not all, but some European countries have implemented mechanisms to limit use of medical technologies. It can take from of commissioning guideline, direct specifications for restrictions of use of procedure in a reimbursement manual, or reimbursement-linked health technology assessments.

Depending on specifics of product and complexity of reimbursement landscape, reimbursement analysis will have between 5 and 15 steps. By working with Synergus you will ensure the most secure and cost-effective way to understand openness of the market, reimbursement mechanism, procedure coding and reimbursement tariffs, and conditions for reimbursement for your product.

In the development of the strategy, it is essential to incorporate the other components in our process to develop a comprehensive market access strategy.

Contact us for more information