Belgian news

Dear colleague,

You undoubtedly heard of the plans of Min. De Block to change the reimbursement of so-called ‘low variable care’ in hospitals. The aim is to eliminate the existing variability in charges (for both patient and RIZIV/INAMI) across different hospitals for many of these patients (e.g. a patient with appendicitis).

As of 1st July 2018  the government plans to prospectively pay an all-inclusive ‘lump-sum’ to the hospitals for a total of 54 ‘low variable care’ patient categories (APR-DRG), including many procedures usually necessitating tissue examination (appendectomy, cholecystectomy, thyroidectomy, inguinal sac surgery, tonsillectomy etc…). The ‘lump-sum’ will cover all medical fees (not materials used) charged by the different specialists involved (including pathologists), and is calculated to represent the ‘median (not mean)’ fees for the particular APR-DRG’s across Belgium.

This means that for these examinations we would no longer be able to ‘charge-per-act’ (including immunostains), but instead receive a fixed sum (based on the activity in previous years). A hospital that performed 100 appendectomies in 2014 will then be payed 100x this ‘median’ sum in advance, to cover for all specialist fees regarding patients with ‘appendicitis’.

In a joint effort (VBS/GBS pathology + BSP + Commission of Pathology) we managed to inform the Cabinet of Min. De Block about the threats we see with this new system, e.g. the danger of ‘underconsumption’ (no longer standard examination of certain tissues) or ‘overdiagnosis’ (shift to malignancy) for financial reasons. We explained that we do fear the loss of our ‘diagnostic independency’ if no accompanying measures are taken.

The coordinator of this ‘low variable care financing’ project (Prof. Kesteloot) told us that the initial plan was indeed to leave it up to each hospital to divide the lump-sum across different specialists (which undoubtedly would lead to fierce discussions in the different medical councils).

In response, however to our motivated letter and on-site discussion the Cabinet now aims to instruct each hospital on ‘how to’ divide the lump-sum, according to RIZIV/INAMI data of previous years. They promised us this measure will be included in the Royal Decree to be published. Hospital management and Medical Councils will be informed on the ‘median fee’ to be given to the pathologists (art. 32: all biopsies + immunostains per APR-DRG charged by pathologists across Belgium in 2014). This means that in the above example your pathology lab will (have to) receive (prospectively) 100x the ‘median fee’ of an appendectomy as calculated by RIZIV/INAMI.

Although this seems a good accompanying measure to eliminate any inappropriate financial incentives for surgeons and pathologists alike (possibly leading to under/over diagnosis), we urge you to stay vigilant. Official policies can still change, or Hospital management/Medical Council might ‘forget’ to tell you about this ‘subdivision of the lump-sum’. We will continue to follow up this important project, and will inform you in due time about any changes.

 

Best Regards,

Prof. Anne Jouret-Mourin (BSP)

Dr. Bernard Maillet (VBS/GBS)

Dr.Kristof Cokelaere, Prof. Birgit Weynand (Commission of Pathology)