Reimbursement in the Inpatient Sector
When introducing innovative medical devices to the market, the fundamental influence of procedures and medical devices on the costs and revenue of a clinic should be considered in addition to reimbursement in the inpatient sector.
This refers, for example, to reductions in length of stay, changes in severity, but also internal process flows of the clinic.
sananet also advises medical technology and bioscience companies on the perspective of their customers, e.g. clinics on priorities in product procurement and the tension between economic efficiency and medical benefit.
In Germany, the flat-rate DRG system is used for reimbursement in the inpatient sector (hospital stay > 24 hours). This has extreme effects on the success of innovative medical products, as individual procedures and products are usually not reimbursed, but rather a disease-related reimbursement takes place. Our expertise lies in the basics of the DRG system, its patient-specific calculation (grouping) and the hospital-internal billing mechanisms.
Current benefit arguments and selection of arguments to be pursued further
Based on the benefit arguments considered above, we can create a rough chain of evidence for each and consider whether the necessary information and figures are available for convincing proof of benefit or cost savings.
The benefit arguments and their provability are evaluated according to two levels:
Convincing, demonstrable argument, but no revenue calculation possible.
Yield calculation with business case possible, so that the improvement in yield can be proven to the hospital (if possible with the hospital’s own figures).
The missing necessary information and figures are evaluated in terms of how high the effort of procurement is.
This could mean, for example, a health economic study, which does not promise a quick solution in terms of time or effort.
As a milestone, the argumentation chains that promise a quick, convincing solution and should therefore be pursued further and implemented in training and sales documents are selected.
Lie time analysis
For the benefit argumentation of a new medical device without direct reimbursement, sananet can conduct a retrospective analysis of the change in length of stay after the introduction of your medical device at one of your hospital customers.
Using the anonymized §21 data of the corresponding patient group, the length of stay in a defined period before and after the introduction of your medical device is compared. This results (if applicable) in a provable cost saving for the hospital.
This requires the cooperation of the clinic!
Graphic: Cost reimbursement according to DRG system in the inpatient sector in Germany. If the “mean length of stay” (mVD) of patients can be shortened by a new medical device, then there is a cost advantage for the hospital (green triangle)
Business Cases
On the basis of the determined length of stay, figures and data, sananet can create a business case for the individual benefits of the medical device.
DRG grouping of different patients as an example for the reimbursement situation.
We have had good experience with designing these business cases as a small program or Excel application that can be filled with the clinic’s individual figures during the sales meeting.
These give the clinics / customers concrete and comprehensible values for the improvement in earnings to be achieved and thus for the benefit of introducing the biomarker.
Cost reduction in anesthesia and intensive care as a sales strategy
According to one study, the costs per ITS day are about 1250 EUR, for ITS days without mechanical ventilation and 1400 EUR for intensive care bed days with mechanical ventilation. Personnel costs (50%) represent the largest cost factors, ahead of medical material costs (18%) and infrastructure costs (16%).
Reducing therapy costs is very attractive for hospitals and an incentive to buy medical devices. Efficient processes are particularly in demand here. Here’s a little thought experiment: If you reduce your sales price by 10%, then with 18% material costs, that’s effectively 1.8% of costs for the hospital. If you reduce the working time by 5%, then with 50% personnel costs this is 2.5% effective costs.
