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86 Musculoskeletal & Neurological Rehabilitation KCE reports 57 5.1.6.5 Detailed overview expenditures evolution convention 7.71 Figure 5.19: Expenditures evolution 7.71 conventions in Euro for the 7 centres between 2000 and 2004. 16.000.000 14.000.000 12.000.000 10.000.000 8.000.000 6.000.000 4.000.000 2.000.000 Source: RIZIV/INAMI 2006 0 € 2000 2001 2002 2003 2004 As the only classification of expenditures in the accounting system is in- and outpatients, a detailed overview of the expenditures evolution (real growth) in the conventions 7.71 based on in- and outpatients is provided. Figure 5.20: Detailed expenditures evolution for in versus outpatients 7.71 in Euro for the 7 centres between 2000 and 2004. 8.000.000 7.000.000 6.000.000 5.000.000 4.000.000 3.000.000 2.000.000 1.000.000 - (1.000.000) Source: RIZIV/INAMI 2006 € Inpatient Outpatient Total 2004 2003 2002 2001
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 87 The majority of the expenditures growth is attributed to outpatient treatment. Only 2003 has a negative overall growth in expenditures, for which there is no clear explanation. Although the majority of treatment sessions is in the segment of inpatients (See Figure 5.20: 62%), growth in the period 2001-2004 is mainly explained by the outpatient segment (cfr. infra). 5.1.6.6 Conclusion convention 7.71 This specific convention can be applied in 7 Belgian rehabilitation organisations for a limited list of mostly acute neurological and musculoskeletal disorders. Price setting is different for each convention. The fee is higher than in the 9.50 convention and the requirements more specified. This convention informally aims at patients with more complex rehabilitation needs even though the pathologies overlap with 9.50 as well as nomenclature. 5.1.7 K-Nomenclature 5.1.7.1 Cost model The rehabilitation nomenclature is part of the nomenclature for medical interventions (chapter V, part 10, art.22 and 23). In the K-nomenclature there are diagnostic acts, therapeutic acts, rehabilitation acts and rehabilitation treatments (complex monodisciplinary or multidisciplinary). For the scope of this study we only included rehabilitation acts and rehabilitation treatments. The price of the sessions in the K-nomenclature is negotiated at a national level within the following actors: • Medicomut • Technical Medical Board (TGR / CTM) Nomenclature can be subject to indexation if negotiated between a representation of the physicians and RIZIV/INAMI. Prices are set at a national level. K-nomenclature is applicable on in and out-patients and is subject to indexation. Knomenclature is a “fee for service” system where one fee covers the personnel and operating costs of a treatment session. K-nomenclature makes a distinction between “rehabilitations acts (K15/20)” and “multidisciplinary rehabilitation treatments (K30/60)”. • Rehabilitation acts: treatment session supervised by a physician specialised in PM&R (mono-disciplinary treatment allowed). • Multidisciplinary rehabilitation treatments: administered by different therapists (at least two disciplines, under the supervision of a physician specialised in PM&R). The unit of payment is based on hourly treatment (K-30: 1 hour; K-60: 2 hours and in the futureK-45: 1,5 hours). So in K30 and K60 the duration of the treatment session is defined as respectively one or two hours whereas K15 and K20 activities have no specified duration per session. The “new nomenclature”, in application since August 2004, introduced new rehabilitation acts and treatments (all acts and treatments listed in Figure 5.21 under post-2004). A limitative list of pathologies (Figure 5.22) for the acts concerning multidisciplinary rehabilitation treatment (K30/60, more specifically codes 558810, -21, - 32, -43) was also introduced in 2004. Another important difference is that while before August 2004 a preliminary agreement on behalf of the mutual insurance was necessary, whereas in the new nomenclature a notification is enough, which might lower the threshold for initiating multidisciplinary therapy. Figure 5.21 shows a general overview of the “new” K nomenclature:
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Dépôt légal : D/2007/10.273/19
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35. Etude relative aux coûts poten
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