Reimbursement in Endoscopy: How Can New Procedures Be Implemented?

Area of Science:

• Medical economics
• Health services research
• Endoscopic innovation

Background:

• New endoscopic procedures require integration into the German diagnosis-related groups (DRG) system.
• The incorporation process can be complex and depends on innovation extent and costs.
• Several potential pathways exist for integrating new procedures.

Purpose of the Study:

• To provide an overview of pathways for implementing new endoscopic procedures in the German DRG payment system.
• To compare survey results on the New Diagnostic and Treatment Methods (NUB) system.
• To detail and compare the implementation pathways of two specific endoscopic innovations within the legal framework.

Main Methods:

• Overview of NUB applications and DRG change request pathways.
• Analysis of legal frameworks governing procedure implementation.
• Comparison of two case studies: radiofrequency ablation for Barrett's esophagus and endoluminal conduits for type 2 diabetes.

Main Results:

• Detailed description of various pathways, including NUB and DRG change requests.
• Survey results indicate a slight increase in positive assessments (Status 1) for innovations (46% vs. 43.7%).
• Negotiation success for Status 1 procedures/drugs improved significantly (77% vs. 53%).

Conclusions:

• Involvement of medical scientific societies is vital for hospital applications and regulatory bodies.
• Scientific statements are valued by regulatory bodies like DIMDI, InEK, and G-BA.
• Radiofrequency ablation followed a continuous change request pathway, while endoluminal conduits were established via NUB payment.