SwissDRG, the organization responsible for managing the Diagnosis Related Group (DRG) system in Switzerland, has announced the timeline for accepting applications for changes to the Diagnosis Related Group system in 2024. This process is crucial for updating and refining the reimbursement system for healthcare services in the country.
Starting on April 1, 2024, registered users will have access to the application form required for proposing changes to the Diagnosis Related Group system. These changes will be considered for inclusion in the 2026 version of SwissDRG and must align with the 2023 CHOP procedure codes and ICD-10-GM diagnosis codes. The application submission window for 2024 applications is set to run from June 3, 2024, to July 15, 2024. During this period, stakeholders can submit their proposals and recommendations for modifications to the DRG system.
One notable change in the application process is that starting in 2022, applications are required to be submitted via personal accounts. Users need to register once with their details and can link older applications to their user accounts. Additional information about this process can be found on the application process page after logging in. Instructions for completing the application form can be accessed in a PDF document provided by SwissDRG. These instructions are crucial for ensuring that the applications are properly filled out and meet the necessary criteria.
Several Types of Applications Related to the Diagnosis Related Group System
Applications for the Further Development of SwissDRG Flat Rate per Case System: These applications pertain to changes and improvements in the reimbursement system’s structure.
Applications for the Further Development of the List of Medications and Substances for Medical Statistics: This category focuses on expanding the list of medications and substances that can be recorded in medical statistics.
Applications for Editorial Changes to the SwissDRG Tariff Structure: Editorial changes encompass modifications to the documentation and structure of the DRG tariff.
Applications submitted for Diagnosis Related Group-related changes are evaluated based on specific criteria outlined by SwissDRG. These criteria have been in effect since May 23, 2013, and help ensure that proposed changes align with the organization’s objectives and goals. Eligible applicants for proposing changes to the DRG system include partner organizations of SwissDRG AG, such as FMH, cantons represented by GDK, health insurers, MTK, H+, and hospitals. Other stakeholder groups are required to submit their applications through one of the eligible organizations.
Stakeholder-Initiated Rules, Definitions, and Coding Revisions Require Specialized Application Process
For applications related to rules, definitions, or coding revisions, stakeholders must use a separate form and submit it to the relevant working groups. Any applications not falling into the aforementioned categories must be submitted directly to the Federal Statistical Office (BFS) or the Federal Institute for Drugs and Medical Devices (BfArM). These organizations are responsible for processing applications related to the further development of the CHOP surgical classification and Swiss coding guidelines.
The announcement of the application timeline by SwissDRG underscores the importance of ongoing collaboration and stakeholder engagement in refining the Diagnosis Related Group system to meet the evolving needs of Switzerland’s healthcare landscape. The careful consideration of proposed changes ensures that the reimbursement system remains effective, equitable, and responsive to the challenges of providing healthcare services in the country.
Resource: Med Tech Reimbursement Consulting, January 23, 2024
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