PMU60 INCENTIVE STRUCTURES OF ADDITIONAL PAYMENTS FOR NEW TECHNOLOGIES IN INPATIENT CARE: DOES IT WORK?

Abstract

Prospective payments do not reflect higher costs of new technologies. Thus, additional payments were implemented in inpatient care to ensure timely access to beneficial technologies. The study compares the principles and incentive structures of Medicare’s New Technology Add-on Payments (NTAP) and payments for new diagnostic and treatments methods in Germany (NUB), and quantitatively analyzes the development of additional payments over time. We conducted a literature review using public domains of regulatory bodies and databases to compare payment approaches according to their designs, implemented reforms, and conducted evaluations. Data of responsible institutions were descriptively analyzed (2005-2018). Expert interviews were conducted to receive physicians’ perceptions of additional payments. Both approaches show major differences in their designs such as the application and payment processes that lead to differing numbers of qualifying technologies over time. While in Germany, a single hospital requests for technology’s qualification, in the US the manufacturer starts the application process. The NUB-approach allows for payment negotiations per technology between insurers and a certain hospital, the payments of NTAP are calculated per case using a calculation scheme based on real hospital costs. Physicians in both countries struggle with the design of the additional payments. In Germany, bureaucratic hurdles and non-transparent criteria and processes are huge problems. In the U.S., the calculation process of technology’s payment leading to a cost compensation of 50% at the maximum limits technology’s utilization. Currently both approaches are part of underlying reforms. Both approaches improved access to technologies compared to prospective payments. However, different designs indicate different incentive structures affecting patient’s access. Implicitly, both designs seem to limit excessive technology utilization. Further studies should evaluate analytically intended and unintended effects of those payments in order to optimize their designs and to ensure that patients have access to beneficial technologies, e.g. by considering ‘Coverage with evidence development’ approaches.