Tuesday, April 16, 2024

On the High-Cost Device List Upcoming Alterations to the NHS Payment Scheme in England

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NHS England has opened a consultation until January 26, 2024, to discuss proposed modifications to the 2023/25 NHS Payment Scheme (NHSPS), which came into effect in April 2023 and spans the financial years 2023/24 and 2024/25, with the proposed changes primarily focusing on the High-Cost Device List (HCDL) and set to commence on April 1, 2024.

The proposed changes to the High-Cost Device List include the inclusion of nine devices, with seven of these recommended through a novel process established by NHS England’s Specialised Services Devices Programme (SSDP) in partnership with NICE (National Institute for Health and Care Excellence). This new process, applicable to devices endorsed by NICE’s Interventional Procedure Guidance (IPG) that meet certain criteria, involves a comprehensive cost-effectiveness analysis for the NHS, a system of prioritization, and a reimbursement mechanism for providers that adhere to NICE guidelines.

Expanding Coverage and Streamlining Funding on High-Cost Devices

Notable among the high-cost devices proposed for inclusion under this new process are the Percutaneous Left Ventricular-Assist Devices (IPG633), Hypoglossal Nerve Stimulation or Upper Airway Stimulation (IPG598), and the Sonata System for the Diagnostic Imaging and Treatment of Symptomatic Uterine Fibroids (IPG689). Additionally, two devices are suggested for inclusion under the regular High-Cost Device List arrangements, including an implantable pulmonary artery pressure sensor.

The key changes for Specialised Services Delegation include the introduction of a minimum elective top-up funding and the establishment of unit prices. Every provider of specialized services is assured a minimum level of elective top-up funding, which is allocated regardless of the volume of top-up-eligible activities.

Furthermore, unit prices are being introduced for four types of specialist radiotherapy: Stereotactic Radiosurgery/Radiotherapy (SRS/T), Stereotactic Ablative Radiotherapy (SABR), Selective Internal Radiation Therapy (SIRT), and brachytherapy. These unit prices, which consist of reimbursement category codes and tariffs, will be a part of the variable component of the Aligned Payment and Incentive (API) model. This model aims to streamline and standardize the funding process for these specialized treatments.

High-Cost Device

 

Strategic Adjustments in NHS Funding and Incentive Schemes

The insights from the 2023/25 NHSPS Consultation indicate several strategic adjustments in NHS funding and incentive schemes. Firstly, the MedTech Funding Mandate will see the addition of a new item, emphasizing the NHS’s focus on innovative medical technologies. Concurrently, there will be a temporary halt to the Commissioning for Quality and Innovation (CQUIN) incentive scheme, signaling a shift in healthcare improvement strategies.

Alongside this, the Evidence-Based Interventions program will undergo payment adjustments for specific procedures, aligning funding with the latest clinical evidence. Notably, there are no proposed changes to Hierarchical Group (HRG) prices, and the general payment approach to support elective recovery will continue as usual. The consultation specifically excludes HRG prices, adhering to the approach outlined in the 2023/25 NHSPS. Furthermore, a separate prices workbook for 2024/25 is set to be released without further consultation, maintaining a stable approach to HRG pricing and elective recovery strategies.

 

Resource: Med Tech Reimbursement Consulting, January 15, 2024

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