The report is available in English with a French summary - KCE

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: