Monday, June 24, 2024 – 9:47
albinfo.ch
(KEYSTONE/Christian Beutler)
The pricing structure for TARMED outpatient medical services, in force since 2004, will be replaced from January 1, 2026 by the new pricing structure for the TARDOC service as well as by a pricing structure for packages. The Federal Council partially approved the two structures during its meeting on June 19, 2024 while setting requirements for the introduction of these two tariffs. Compared to the proposals submitted by the tariff partners, adaptations will have to be made in order to coordinate the two tariffs which were developed separately. In order to simultaneously introduce TARDOC and the first packages on the planned date, the tariff partners will have to submit an implementation contract to the Federal Council by November 1, 2024. This contract will be drawn up under the aegis of the new Tariff Organization outpatient medical services (OTMA SA).
The health insurance law provides in particular for two types of rates for outpatient medical services: service rates and package rates. The TARMED service pricing structure is currently the main basis for calculating outpatient medical services. With more than 4,600 positions, it includes almost all medical services provided in medical practices and in the outpatient hospital sector. In force since 2004, TARMED has never been completely revised and has not been updated in recent years. There is general agreement that this pricing structure is now outdated and needs to be replaced.
The pricing partners, who represent service providers (FMH and H+) and insurers (curafutura and santésuisse), have been working on revising TARMED for years. In 2021 and 2022, the Federal Council was unable to approve the presented versions of the tariff structure for the TARDOC service because they did not meet the requirements set by law, for example in terms of cost neutrality. The Federal Council then invited the various stakeholders to agree and simultaneously continue their work on the introduction of packages for certain outpatient medical services. In December 2023, the Federal Council received new requests for approval for the pricing structure for the TARDOC service, submitted by the FMH and curafutura, and for the pricing structure of the packages, submitted by H+ and santésuisse.
Evolution since 2022
The Federal Council considers that the situation has evolved since 2022. Since January 1, 2024, the new Outpatient Medical Tariff Organization (OTMA SA), which brings together service providers and health insurers, has started its activities. Its objective is to develop and develop national pricing systems for outpatient medical services. Parliament also amended the health insurance law and established the primacy of the flat rate over the service rate. Finally, progress has been made by tariff partners. Concepts for eliminating TARDOC shortcomings were, for example, established and the uniformity of packages was improved. TARDOC allows more precise billing for consultation times and better takes into account the specificities and needs of family medicine. As for packages, they make it possible to simplify invoices and limit incentives to increase the quantities of services invoiced. The Federal Council believes that both tariff structures will soon be ready for introduction. This is why it decided to approve TARDOC and packages simultaneously. Simultaneous introduction also makes it possible to reduce the administrative burden on health stakeholders by avoiding two successive reforms.
Partial approval and coordination required
The approval of the Federal Council is, however, partial and adaptations are still necessary so that the two tariffs can come into force on January 1, 2026. The two tariff structures, which were developed separately, must be better coordinated, in particular the concept of neutrality costs to avoid unjustified additional costs. Adaptations must also be made to the package level. Currently, their calculation is based on data only from hospitals. However, the question of whether they are also suitable for medical practices needs further investigation. This is why the Federal Council is demanding that, as a first step, the use of packages in medical practices be significantly reduced.
The Federal Council has developed a precise catalog of criteria to be respected for tariff partners. It is the OTMA which will carry out the necessary work and manage the coordination between the different actors. In order to be able to simultaneously introduce TARDOC and the packages on the planned date, the tariff partners will have to submit an implementation contract to the Federal Council by November 1, 2024. If the partners should fail, it is the Federal Council which will set coordination rules so that both structures can come into force.
/admin.ch/
