Download Acute Pain Management

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
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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 €
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10
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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 €)
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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
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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
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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
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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
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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
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New Honoraria
(from 1-2-2013)
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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
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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€
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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
– …
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