FEES IN PALLIATIVE CARE
Fixed palliative care pricing is crucial for the development and expansion of palliative care in Switzerland. The foundations for any pricing system are good quality, consistent definitions and systematic documentation of performance data. It is the responsibility of each institution to ensure these requirements are met.
Particular attention should be paid to service providers in specialised palliative care. If special rates are applied here, service providers must demonstrate that what they are offering and delivering is over and above general palliative care. Patients, as well as their family and friends, should be able to confidently request specialised palliative care services, safe in the knowledge that those services will be provided exactly as advertised. According to the definition of palliative care in Switzerland, these services fall into three categories:
- Inpatient treatment provided by acute care hospitals and other medical institutions
- Mobile palliative services
- Long-term specialised palliative care
palliative ch, together with other stakeholders and service providers, advocates the provision of supporting measures for these particularly disadvantaged and vulnerable patients within the context of current and future pricing. This is the only way to ensure that terminally ill and dying patients have access to adequate palliative medical care.
Palliative Care in Outpatient and Long-Term Departments
Services by doctors and nurses or carers are compensated separately. This will also continue in future. Doctors will continue to charge for their services via the TarMed fee system. Nursing care services will be paid according to the new scheme of care financing from 1.1.2011 onwards.
The so-called Bundesgesetz zur Neuordnung der Pflegefinanzierung (Federal Act on the New System of Care Financing) regulates the allocation of the costs of care and their cover by health insurance funds, insured persons and the cantons/municipalities. The most important changes relate to the Ordinance on Patients' Care Services, Krankenpflege-Leistungsverordnung KLV (PDF in German).
The most important changes due to the new care financing are:
- the obligatory health insurance pays a fixed contribution, following a graded scheme according to the time expended, towards the care services ordered by the doctor.
- the so-called acute and transitional care. This can be claimed after leaving an acute-care hospital if the setting of an acute-care hospital is no longer necessary but the needed care is more than that provided by the usual home care (Spitex). It lasts up to 14 days and can be done as an outpatient at home or in a long-term institution.
Even in the new care financing system there are still some gaps in the types of care covered. The financing of these will have to be regulated at the cantonal level. Mainly this means the increased care needs of patients at the end of their lives, and indeed also services which are not in immediate proximity to the patient such as coordination tasks, double invoicing (concurrent outpatient and inpatient services accounts e.g. in interface management), and the compensation for emergency standby services, night work, care of relatives and psycho-social care.
Palliative Care in the Acute Somatic Field (Acute-Care Hospital)
Palliative care is predominantly provided as part of primary medical care. It is important that patients in palliative situations continue to have the opportunity to be treated by acute care hospitals if this is desired or necessary.
For specialised palliative care, an important reorganisation of the grouper codes was undertaken within the SwissDRG system: palliative care was added as a special case in the major diagnostic categories (MDC). Consequently, the case assessments are no longer primarily based on the major medical diagnosis (as is the case with cancer, for example). This more effectively takes into account the fact that the complexity of treatment in palliative situations does not depend on the diagnosis. The current weekly additional charges are also ‘automatically’ included in the case assessment and no longer appear as extras. The algorithm continues to ensure that cases are assessed on a weekly basis (the hospital receives more money than it would without palliative care, even in the third week). This counteracts the ethically problematic incentive to shorten periods of hospitalisation.
Palliative stations that are part of acute care hospitals must join the SwissDRG system as of 2016 and provide the relevant data. This decision was made by the SwissDRG administrative board. The Swiss Federal Council has also decided that from 2019 at the latest, all palliative institutions with a service mandate for the treatment of acute patients must complete their invoicing in accordance with DRG.
Palliative Care in Specialised Institutions
Palliative stations and nursing homes with hospital status are counted as specialised palliative care institutions in the inpatient category. Some of these institutions were previously exempt from the SwissDRG system and invoiced using day rates. The previously mentioned ruling means that this will change by the start of 2019 at the latest.
Working Group: Fees in Palliative Care
In effect, the working group is composed of three subgroups:
- Acute inpatient treatment rates
- Mobile palliative services
- Specialised long-term care rates
The working group/subgroup for inpatient rates is made up of representatives from most palliative hospitals and palliative stations in Switzerland. The delegates from each institution include medical professionals and specialists in pricing/coding. The working group represents the interests of palliative ch. It collaborates with other stakeholders such as health insurance associations, the Swiss Federal Office of Public Health, the Palliative Care Platform and SwissDRG. The group has a rotating system of leadership.
Current contact person:
Please direct any questions to the office of palliative ch: firstname.lastname@example.org
We are currently looking for people to form the other two subgroups and represent the issues of mobile palliative care and specialised long-term care rates. Participants will help to develop a pricing framework in collaboration with the existing group. Please contact the palliative ch office if you are interested in getting involved.