Dutch governments sets structural reimbursement remote patient monitoring
Big news broke suddenly this week in the world of remote patient monitoring. The Dutch Health Authority (NZa) published a number of changes to drive the movement towards tailored care over the next year. And this includes a new structural reimbursement for telemonitoring. How does this reimbursement work? And why is it relevant? This blog provides a brief overview and advice for those who want to know more about how this can make the difference to your home monitoring service.
Pilots, pilots, pilots
Long before the Corona pandemic, many hospitals were already implementing remote patient monitoring with Luscii for heart failure, COPD and pregnancy hypertension. Even though it quickly became clear that patients valued the service and initial studies proved how remote patient monitoring could help reduce care (such as admissions), no structural funding was yet in place. Hospitals could make arrangements with insurers but this was tailor-made and took a long time. remote patient monitoring remained in the domain of 'pilots, pilots and more pilots' with brave directors and healthcare professionals soldiering on despite the financial limitations.
2018: Breakthrough with Zilveren Kruis and Menzis
A breakthrough finally arrived around 2018. Healthcare procurement director Olivier Gerrits from insurer Zilveren Kruis announced during the European eHealth Week to reimburse remote patient monitoring for patients with heart disease (the Luscii powered Heartguard). Insurer Menzis later followed suit. After positive results in the Achterhoek region at Slingeland Hospital, Sensire and NAAST-ZCN, Joris van Eijck announced, together with Maarten van Rixtel, that the Luscii powered COPD in Sight would be actively procured. A publication by Jorien van der Burg, MD, PhD that followed research by National eHealth Living Lab (NeLL), supervised by Niels H. Chavannes, MD, PhD, lay the foundations for this decision. Coöperatie VGZ also included the initiative in their list of good examples of sensible care and the Dutch Hospital Association elaborated the business case in a white paper that continues to be enhanced as part of the Transformation Agenda 2020-2024.
But despite these extremely important steps, scaling up these reimbursements proved difficult. Not all insurers wanted to participate and every reimbursement remained tailor-made, making it difficult to replicate in other hospitals. Plus, the reimbursements were only accessible to specific patient groups while remote patient monitoring had potential on a much wider scale. This then formed the base for many of the frontrunners we see today, such as Luscii customers Isala, UMC Utrecht and Tergooi MC.
2019: CZ strategic healthcare procurement
Just before the Corona pandemic, another important step was taken. Initiated by Menno Jansen and colleagues, the strategic innovation programme from insurer CZ insurance enabled hospitals to make tailored agreements for the first time for the region-wide deployment of remote patient monitoring. The programme proved important as it came with the condition that remote patient monitoring was to be widely deployed, hence moving beyond the pilots. It turned out to be a godsend and hospitals such as Luscii customers Albert Schweitzer Hospital, Bravis Hospital and Canisius Wilhelmina Hospital were able to introduce remote patient monitoring on a large scale very quickly. And this happening just before Corona meant that healthcare organisations in most regions had taken the first steps towards remote patient monitoring. Something that may have made the difference during the Corona pandemic, as it was these frontrunners who managed to deploy Luscii COVID-19 Home program, as developed at St Antonius Hospital and widely shared by Hans Hardeman and colleagues, on a large scale to enable the early discharge of Corona patients.
2021: Optional reimbursement for remote patient monitoring
Amsterdam's OLVG showcased its innovative strength during the Corona pandemic through a variety of initiatives that we at Luscii were privileged to be a part of. Besides Corona-specific innovations, the Luscii powered 'virtual heart clinic' was rolled out, for example, led by cardiologist Robert Riezebos, among others, and CMIO Paul Bresser scaled up e-coaching for COPD. Based on the data from Zilveren Kruis and the OLVG, the Dutch Health Authority established six optional reimbursements for remote patient monitoring. This laid the definitive foundation for structural funding.
2023: Structural funding of remote patient monitoring
Despite these vital steps and the pioneering work of many parties, remote patient monitoring could not be claimed separately until today (it could only be registered and not financially accounted for). This is now about to change. From 2023 onwards, remote patient monitoring, referred to by the NZa as telemonitoring, can be registered and claimed independently.
"I personally think this - also internationally - is truly unprecedented" - Prof. Daan Dohmen, PhD -co-founder of Luscii and professor Digital transformation in healthcare
If you look at the section on remote patient monitoring in the newly published Dutch Medical Specialist Care Regulations (NR/REG-2306a, article 24.69), you can see that a lot of thought has gone into this new care activity. For instance, there is a classification of clinical data collection and interpretation.
The care activity may be recorded a maximum of once every 120 days and can be performed for multiple (chronic) conditions. It means hospitals can get a max tariff of €164,13 per 120 days. Personally, I think perhaps the most eye-catching point is that in order to get this tariff, the digital health offered should replace regular care. This means true transformation and not simply adding this care 'on top' of the existing format. I personally think this - also internationally - is truly unprecedented.
No one is left behind
With this giant leap forward, it is now possible to actually have this type of care reimbursed on a structural basis. Interestingly, this is also the first time this can be achieved on a broad scale, with doctors and nurses already using Luscii remote patient monitoring for more than 70 conditions. The requirement that remote patient monitoring actually replaces regular care is of course crucial in this respect. As is ensuring that we continue to research effectiveness and quality to keep learning, which we encourage through our Luscii Library, where healthcare professionals share their knowledge and work together. But it means something else too. With the growth of remote patient monitoring, we have a responsibility to maximise our commitment to digital inclusion. 'No one is left behind', as we call it. More on that in an upcoming article, as we are working exceptionally hard to make this happen and I believe it is worth sharing its importance.
"With the growth of remote patient monitoring, we have a responsibility to maximise our commitment to digital inclusion: 'No one is left behind'. " - Prof. Daan Dohmen, PhD - co-founder of Luscii and professor Digital transformation in healthcare
Finally, how does the reimbursement work in detail?
This brief overview illustrates the path towards this new structural funding. I have deliberately shared as many links as I could find to allow you to review the underlying sources yourself. Nevertheless, I understand you might still be wondering how it will all work in detail in your own remote patient monitoring service. We will address this question on the 12th of October at LMDC22. In fact, that evening we will host a special workshop on remote patient monitoring reimbursement. Independent advisor Bernard Creutzburg (former senior advisor for wide-scale care innovation at NZa government body), together with Rutger de Vries (care procurement senior manager at insurer Zilveren Kruis), Menno Jansen (care innovation strategic programme manager at insurer CZ) and Ronald Scheffer (Luscii), will answer all the questions about remote patient monitoring that dare not be asked.
The Luscii Medical Developer Conference (#LMDC22) is a special conference for doctors, nurses and digital care project leaders from healthcare organisations to share their knowledge. Over 300 such medical developers from home and abroad will come together. The conference is accredited and free of charge. Due to high interest, we have arranged extra space in the DeLaMar Theatre. You can view the full programme and sign up at www.luscii.com/lmdc. Once registered, you can select your preferences for the workshops within the Luscii app.