The Swiss medical tariff, TARMED is being updated to a new version, the TARDOC. However, the controversial process has taken longer than expected. What is going on?
Summary:
The TARMED covers tariff rates for medical services in the outpatient sector. It also contains diagnostics tariffs, such as those for next-generation-sequencing, histopathology, and cytopathology
Experts argue that the TARMED is outdated and requires an update to keep its 12 billion CHF billing under control.
The newest TARDOC proposal submitted earlier this year was rejected by the Federal Office of Public Health. Stakeholders have to agree on a collective proposal implemented in a cost-neutral way.
Why is TARMED being updated to TARDOC? Why is the change needed?
The TARMED is one of the 3 diagnostics-relevant tariff lists in Switzerland, the other 2 being the Analysenliste (for laboratory diagnostics) and the MiGEL (for medical devices and aids). It is used to calculate tariff rates for medical services in the outpatient sector.
Some diagnostics tests such as next-generation sequencing (NGS), histopathology and cytopathology are covered by the TARMED.
The TARMED structure has not been changed since 2004 and both insurers and medical practitioners agree that the list is outdated, as medicine and technology have progressed since then.
Experts argue that billing with the existing list may lead to false incentives which can affect service provider behaviors, and in turn, could have negative consequences for both cost efficiency and the quality of service provision.
The current TARMED list bills for 12 billon francs each year and an update is timely.
How this change will affect diagnostics?
It is not clear how the change will affect diagnostics yet, as multiple partners including the FMH (Swiss Medical Association), Curafutura and SanteSuisse (both insurer representatives), and H+ (Association of Swiss Hospitals) have yet to agree on the final version.
However, what is clear is that the TARDOC will be implemented in a cost-neutral manner i.e. does not result in increased costs. All stakeholders must also agree on the proposal, which needs to be accepted by federal authorities.
Earlier this year, the Federal Office of Public Health (FOPH), rejected the latest proposal from partners including FMH Curafutura and MTK the Medicine Tariff Commission.
First, according to the FOPH, the new proposal only partially met legal requirements and fell short in areas of cost-effectiveness and fairness of the tariff structure. Cost-neutrality was also not ensured and the simplification process of the tariffs was not sufficiently documented.
Second, it had failed to implement FOPH recommendations provided for previous versions. Some of these recommendations include finer points on cost models and the basis of calculations.
·Third, not all partners agreed on this version as required.
The Federal Council has called for all partners to conduct an in-depth discussion on its earlier recommendations and jointly agree on a revised TARDOC.
Revising the tariff structure is no easy task and partners are working hard on this uphill climb.
Centivis is monitoring the situation for updates.