Outpatient case rates

Although CSS is generally in favour of flat rate compensation for individual outpatient services and procedures, it opposes zero night DRGs. The main point of criticism is that, at present, the proposed flat rates for certain outpatient hospital services can only be calculated on the basis of inpatient services. However, it is essential for this calculation to be based on outpatient data (sourced both from hospitals AND medical practices). Calculating these rates on the basis of inpatient service and cost data contravenes the Federal Health Insurance Act (KVG Art. 43 para.4; KVV Art. 59c) as it does not reflect the actual outpatient service and cost structure. Where there is no suitable outpatient service and cost data available for developing a tariff structure, then such a basis must first be created. It is further intended to restrict the use of flat rates to outpatient treatment in hospitals. This would create new interfaces and lead to unfair differences in the amounts paid for outpatient treatment depending on whether it was administered in hospital or in a doctor’s practice. This situation would not only go against the principle of cost-effectiveness, it would also run contrary to the idea of “the same rates for the same services regardless of where they are provided” and create new false incentives. That is why outpatient case rates must apply to the entire spectrum of outpatient service provision.

Outpatient flat rates play a prominent role in the public discussion due to the first package of measures, i.e. the proposal to enshrine national flat-rate structures in law. A wide variety of contractually agreed outpatient case rates exist alongside Tarmed and are a functioning reality. CSS stands by the following principles: There should be only two tariff organisations for medical services, i.e. SwissDRG for inpatient care and another tariff organisation for outpatient care. The key partners are to be represented in both organisations. The achievements of the existing tariff office ats-tms AG should be integrated. There should be two uniform tariff structures at the national level: one for inpatient care (SwissDRG) and another for outpatient medical care. Tardoc, the tariff structure with updated medical and economic benchmark figures, will form the basis for future flat rates for outpatient medical services. The outpatient tariff organisation will define which services within the outpatient tariff structure are to be compensated by a fee-for-service tariff and which are to receive a flat rate.

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