Innovazione tecnologica e sistema di codifica delle prestazioni

Transcription

1 Le determinanti della diffusione di nuove tecnologie sanitarie. i Un analisi i empirica i Milano, 18 settembre 2014 Innovazione tecnologica e sistema di codifica delle prestazioni Stato dell arte in Italia Giuditta Callea 1, Giuseppina Petrarca 2, Rosanna Tarricone 1 1 Cergas Università Bocconi and European Health Technology Institute for Socio-Economic Research, 2 Assobiomedica

2 Introduction ti A frequently updated classification system, that allows the identification of technological innovation, would be highly desirable: It would allow to compare alternative treatments and technologies in terms of outcomes (e.g., average length of stay, infection rates, mortality rates, readmission rates) and consumption of resources (e.g., hospitalizations, outpatient visits, drugs). It would highlight hli ht differences in uptake rates of new technologies within a country and the implications in terms of patients equity of access. It would allow empirical i estimates t on the determinants t that t affect the diffusion of new technologies. It would allow the Regulator to make evidence-based decisions. 2

3 The Italian classification system The Italian system derives from the original US HCFA-DRG system, whith several implications: CMS DRGs reflect Medicare population. CMS recommendation As we have stated frequently, our primary focus in maintaining the CMS DRGs is to serve the Medicare population. We do not have the data or the expertise to maintain the DRGs in clinical areas that are not relevant to the Medicare population. We continue to encourage users of the CMS DRGs (or MS-DRGs if adopted) to make relevant adaptations if they are being used for a non-medicare patient population. (CMS, 2007) ICD-9-CM codes for procedures reflect Medicare reimbursement (e.g., implantation or replacement of neurostimulator pulse generator). 3

4 National updates of the classification system Updates in the classification system are not systematic. Version of DRG Year of introduction Version of ICD-9-CM HCFA HCFA CMS CMS The adoption of new codes occured at least two years after their development high h risk of an outdated t d classification system, unable to identify recent innovations. 4

5 Aims and objectives The goal of this work is to give a snapshot of the Italian classification system and the possibility to match several technological innovations with existing ICD-9-CM codes. The analysis is the preliminary step for the empirical investigation of the determinants that impact the diffusion of innovative health technologies in the Italian NHS. 5

6 Methodology (1) Identification of a short list of 9 medical innovations, either breakthrough or incremental, by EHTI Board, Excom, and Eucomed Members. 6

7 Technology Fractional Flow Reserve (FFR) Cardiac Ablation for Atrial Fibrillation Neuromodulation (e.g., SCS) Implantable Ocular Lenses (IOL) Insulin Pump Renal Denervation (RDN) Left Atrial Appendage Closure (LAAC) CRT therapy ICD therapy Description Technique used in coronary catheterization to measure pressure differences across a coronary artery stenosis Procedure used to selectively destroy areas of the heart that are causing a heart rhythm problem Modulation of the nervous system through the electrical activation of neurons in the body Lens implanted in the eye used to treat cataracts or myopia Medical device used for the administration of insulin in the treatment of diabetes mellitus Minimally invasive, endovascular catheter based procedure using radiofrequency ablation aimed at treating resistant hypertension Treatment strategy to prevent blood clot formation in patients suffering from atrial fibrillation Cardiac resynchronization therapy device designed to treat heart failure Electronic device that constantly monitors heart rhythm and delivers energy to the heart muscle in case it detects a very fast, abnormal heart rhythm 7

8 Methodology (2) Development of a list of criteria, aimed at verifying the possibility to match the technologies in the short list with ICD- 9-CM codes, that was circulated among MDs manufacturers. 8

9 Criteria Is it possible to identify the use of the focal technology in Hospital Discharge Forms (Schede di Dimissione Ospedaliera - SDO)? What is the DRG code linked to the use of the technology? What are the ICD-9-CM codes for diagnosis and procedures linked to the use of the technology? Have Italian regions differentiated the ICD-9-CM codes? If so, which Regions did? Have Italian regions adopted special payment mechanisms to enhance the use of the technology (e.g., supplementary payments on top of DRG rate, separate payments)? If so, which Regions did? 9

10 Results Matching not possible 3 Matching possible 2 Partial matching 4 10

11 Matching possible Only for 2 technologies out of 9 the matching is possible in Italy. Technology DRG ICD-9-CM code for diagnosis ICD-9-CM code for procedure CA-AF 518 or LAAC

12 Matching impossibleibl In 3 cases the ICD-9-CM CM codes currently in use are dated and unable to identify the use of the following technologies: Fractional Flow Reserve Insulin Pump Renal Denervation. 12

13 Partial matching (1) Even when codes exist, they are not sufficiently detailed to identify the level of innovation for 3 technologies. Technology Implantable Ocular Lenses CRT therapy ICD therapy Matching with ICD-9-CM codes Partial: no details on the kind of lens Partial: no details on the kind and generation of device Partial: no details on the kind and generation of device 13

14 Partial matching (2) The traceability of SCS in SDOs is problematic: The ICD-9-CM procedural codes do not distinguish between insertion and replacement of neurostimulator pulse generator. The same ICD-9-CM procedural codes are used for several types of neurostimulation, i.e. SCS, DBS and SNM. To be able to isolate SCS, the link with procedural code insertion or replacement of spinal neurostimulator lead(s) is required. But only in some cases the implant of pulse generator and of electrode occurs in the same hospitalization. More frequently, the electrode is implanted in a first hospital admission, followed by a second one in which the pulse generator is implanted. To be able to univocally identify SCS, one should: Separate cases with simultaneous implantation Select individual codes of patients who received the insertion of spinal neurostimulator For those patients, identify subsequent admissions in which a neurostimulator pulse generator was implanted. The above described process relies on the possibility to univocally identify patients through their individual codes. 14

15 Technology Cardiac Ablation for Atrial Fibrillation Left Atrial Appendage Closure (LAAC) Implantable Ocular Lenses (IOL) CRT therapy ICD therapy Fractional Flow Reserve (FFR) Insulin Pump Renal Denervation (RDN) Regional differentiation of codes No Special Payments Neuromodulation Yes SCS Supplementary payments for SCS (in 3 regions) and DBS (in 10 regions) No 15

16 Conclusions This work aimed at verifying the possibility to match a set of 9 medical technologies with the ICD-9-CM CM codes currently used in Italy. Our results show that the classification system currently used in Italy has some limitations as for the possibility to identify recent technological innovations (only 22% of the analyzed technologies is fully traceable) and therefore should be implemented. The two fully traceable technologies have been further investigated in the empirical part of the study. CRTs and ICDs are currently under investigation in the FP7 research project led by Bocconi University Methods for Health Technology Assessment of Medical Devices: A European Perspective - MedtecHTA Home. 16

17 Policy implications An optimal classification system allows the perfect matching between technologies and DRGs through ICD-9-CM CM codes. Tecnology ICD-9-CM codes DRG Different options are available: Regular updates of the classification system Linking hospitalizations with information on MDs. Such a system would allow the possibility to analyze and evaluate the use of technological innovations, supporting evidence-based policies and programs aimed at governing the diffusion of new medical technologies. 17

18 Thank you! it 18