Reimbursement in the NHS: how should companies with innovative technology prepare for the launch of their product in this area?
Understanding how healthcare providers are reimbursed is important for suppliers, to enable them to better describe the benefits of a new healthcare technology.
Payment by Result (PbR) links payments to NHS providers to the activities they deliver. Tariffs are set on the basis of Healthcare Resource Groups. A Healthcare Resource Group (HRG) is a group of health-related activities that have been judged to consume a similar level of resources. For instance, there may be a number of different knee-related procedures that all require similar levels of clinical care and take a similar duration. They may all be assigned to one HRG.
The system of HRGs and the associated Grouper software have been developed by the Casemix Service16. HRGs are used as a means of determining fair and equitable reimbursement for care services rendered. HRGs are consistent “units of currency‟ used to support standardised healthcare commissioning across the service.
This enables the NHS to:
support activity costing, to inform national tariff setting processes
collect patient activity information, to ensure that providers are paid for the services they deliver
provide information to support epidemiological studies and service planning.
For every patient episode (a period of care under one consultant), the patient is assigned an HRG code using the Grouper software. Grouper translates diagnosis or disease classification usually based on the International Classification of Diseases system ICD1017 and procedure classification based on operation procedure codes (OPCS)18 into an HRG.
Because of soaring healthcare costs reimbursement is only given if there’s clinical and economic value. Investors require a reimbursement strategy including timelines and strategy. MacGregor Rogers can help to plan reimbursement strategy at an early stage rather than just prior to launch.