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

62 Musculoskeletal & Neurological Rehabilitation KCE reports 57
5.1.2.2 Rehabilitation activities
• A large variability mainly explained by historical factors
• A yearly price correction limited to the price index;
• Absence of a link with “working units” or “justified activity”
• Absence of a link with the large variability of patient characteristics.
The payment of rehabilitation activities varies as a function of provider activities within an
a priori defined budget. The budget can be exceeded but in case of a significant overrun,
corrective measures – such as an adjustment in the fee schedule or an increase in copayment
– can be undertaken. There is no link between the price and the real cost of
therapy (prospective payment).
Rehabilitation activities are financed by two different systems: nomenclature and
conventions. Nomenclature covers mono-disciplinary as well as multidisciplinary activities
(R for mono-disciplinary speech therapy, M for mono-disciplinary physical therapy and K
for physical medicine & rehabilitation). The systems for multidisciplinary rehabilitation
activities, scope of this study, will be analysed in detail in the following paragraphs (Knomenclature
and conventions).
There are no significant differences between the nomenclature and the conventions, nor
from a financial point of view, nor concerning accessibility, content, intensity or duration
of therapy (Figure 5.5).
Figure 5.5: Variable payment: Unit of reimbursement
Sponsor
Financial risk
Provider
Variable payment:
Unit of reimbursement
Per item-of-service
Per diem
Per case
Per episode
Per patient
Per period
K-nomenclature
Conventions
The unit of reimbursement is per item-of-service for both systems. However, the unit of
reimbursement is for some cases within the conventions rather per diem because the
item-of-service is a 6 hours therapy session, while the item-of-service within the Knomenclature
is limited to a 1 or a 2 hours therapy session.
The beneficiary of the budget differs. For K-nomenclature the physiatrist is the paid
provider whereas for conventions the paid provider is the institution. However, the
received budget must in both cases be distributed over physiatrist, therapists and
institution.
The type of beneficiary has an impact on:
• The position of the physiatrist in the discussion concerning
distribution of the budget