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Acute Pain: a comprehensive approach Tarification, Economics, Subsidies Maurice Lipszyc, M.D. NIHDI Health Care Departement Medical Direction June 15th 2013 1 Outline • NIHDI • Acute Pain and NIHDI 1. Nomenclature a. b. Procedures 2013’s modifications 2. Medications • Future • Summary 2 Federal authorities • Preparation and realisation of public health policy The organization and financing of health care institutions The organization of health professions The emergency medical Ministery of Health NIHDI Public social security institution • General organization and financial management of the compulsory health care and benefits insurance Organize reimbursement of medical costs Elaborate legislation and regulation Monitor the evolution of health care spending Inform health care providers, sickness funds and the insured, and to ensure they apply the legislation and regulation correctly Organize the negotiations between the different actors involved in compulsory health insurance National Institute for Health and Disability Insurance (NIHDI-INAMI-RIZIV-LIKIV) • The NIHDI is a public social security institution that manages and supervises the compulsory health care and benefits insurance in Belgium. 4 National Institute for Health and Disability Insurance (NIHDI-INAMI-RIZIV-LIKIV) The main roles of the NIHDI is to: Organize and manage the health care insurance Organize and managing the benefits insurance Inform the health care providers about the rules of the compulsory insurance Supervise the correct application of the rules 5 Departments of NIHDI General Managment Committe CEO & Internal audit Deputy CEO ± 1400 staff members Cell Cell Communication Modernisation Cell Datamanagement Cell Expertise & COOPAMI Safety information Health care Departement Benefits Department Medical Evaluation and Inspection Department Prevention service Administrative Inspection Department General Support Departments Fund for Medical Accidents Acute Pain Management • Nomenclature 7 Acute Pain Management Procedures Article 12 §1st d) of the Belgian nomenclature : 1) Patient-Controlled Peridural Analgesia (P.C.E.A.) 2) Patient-Controlled Intravenous Analgesia (P.C.I.A.) During a single hospitalisation, one of these procedures could be charged everyday, for a maximum of 4 days, Data (2010): • 15% of the surgical patients got one procedure (50/50) • 1.1% of the patients had both techniques • Mean length : 2.8 days 8 Budget of the anesthesiologists (2011) • Honoraria for hospitalized patients : 282.560.806 € • Honoraria for acute pain management : 16.920.114 € ( 6 %) – Hospitalized patients : 16.868.059 € (> 99%) – Ambulatory patients : 52.055 € 9 10 11 Acute Pain Management 2012’s savings In 2012, the National Committee of Physicians & Sickness Funds had to save 150 millions euros: 75 millions € to be saved on medical honoraria/fees - 15 millions € on honoraria of the anesthesiologists - 3.3 mi € on article 12 §1st d) of the Belgian nomenclature (16.9 mi €) 2 solutions: i. ii. Equal reductions on both procedures Asymetrical reductions: PCEA: K 77 (144,86 €) PCIA : K 56 (105,35 €) 12 The collective negotiation process in the health insurance Minister of Social Affairs and Public Health Management Committee for Health Care Insurance Sectorial negotiations General Council Conventions and agreements commissions Technical councils Preparatory negotiations Workgroups 13 Acute Pain Management Today’s Procedures (from 1-2-2013) 1) Patient-Controlled Peridural Analgesia (P.C.E.A.) 2) Patient-Controlled Intravenous Analgesia (P.C.I.A.) + 2 rules of interpretation 14 1) P.C.E.A. (202311 – 202322) • Forfaitair honorarium voor de post-operatieve pijncontrole door de geneesheer-specialist in de anesthesie-reanimatie, door middel van peridurale, epidurale (PCEA, patient controlled epidural analgesia) of trunculaire pijnverdoving met toezicht, na een heelkundige ingreep of na polytrauma; inclusief het gebruikte materieel en de plaatsing, met uitsluiting van de gebruikte farmaca • Honoraires forfaitaires pour le contrôle de la douleur post-opératoire par le médecin spécialiste en anesthésie-réanimation, par voie péridurale, épidurale (PCEA, patient controlled epidural analgesia) ou tronculaire, avec surveillance, après une intervention chirurgicale ou après polytraumatisme, y compris le matériel utilisé et le placement, à l'exclusion des produits pharmaceutiques 15 2) P.C.I.A. (202333 – 202344) • Honoraires forfaitaires pour la mise en place et la programmation avec surveillance d'une pompe à analgésie pour administration d'un produit de type morphinique par voie intraveineuse (PCIA, patient controlled intravenous analgesia) après une intervention chirurgicale ou après polytraumatisme, y compris le matériel, à l'exclusion des produits pharmaceutiques • Forfaitair honorarium voor de plaatsing en de programmering van een pijnpomp, met toezicht, voor intraveneuze toediening van een morphinomimeticum (PCIA, patient controlled intravenous analgesia) na een heelkundige ingreep of na polytrauma; inclusief het gebruikte materieel, met uitsluiting van de gebruikte farmaca 16 Interpretatieregels – Règles d’interprétation K.B. 14.1.2013 (in werking 1.2.2013) De verstrekkingen 202311-202322 en 202333-202344 kunnen slechts éénmaal aangerekend worden tijdens een zelfde hospitalisatieperiode. De verstrekking 202311-202322 is niet cumuleerbaar met de verstrekking 202333202344 A.R. 14.1.2013 (en vigueur 1.2.2013) Les prestations 202311-202322 et 202333-202344 peuvent être attestées une seule fois au cours d'une même période d'hospitalisation. La prestation 202311-202322 n'est pas cumulable avec la prestation 202333202344 17 New Honoraria (from 1-2-2013) 18 In-hospital chronic pain management (I) • Ministery of Public Health • Starting July 1st 2013 • 2 levels’ organization for chronic pain : 1) multidisciplinary pain-teams : 1 / hospital 2) multidisciplinary pain-centers: 36 in Belgium and 13 pediatric teams 19 In-hospital chronic pain management (II) Annual budgets: • multidisciplinary pain-teams : 7.220.000 € • multidisciplinary pain- centers: 9.756.000 € • Pediatric pain-teams: 500.000€ 20 Summary • Positive: – – – – – 2 public organizations involved in the Health system Independent management of the health care and the funds available Individual spending for health is under control 2 procedures are available for hospitalized patients the medications , but the local anesthetics, are reimbursed • Negative: – Acute Pain Service must be subsidized by the physicians or the institution – Elastomeric infusion pumps are not reimbursed – … 21 [email protected]