The fact that TARMED, the physician tariff for outpatient services introduced in 2004, is outdated is old news. Nevertheless, any improvement in the situation in the near future is on shaky ground. For example, the Federal Council has rejected the newly developed TARDOC rate structure for the time being. What is left is a shambles and disputes between the two sides of industry, who actually only agree on one thing: A better solution is urgently needed.
Too little money for some, too much for others. For example, while important services in psychiatry and primary care are not reimbursed to cover costs, other medical services in the outpatient sector are overcharged. This is the current reality. The reason: The current physician tariff TARMED no longer corresponds to the technical realities of outpatient medicine and leads to an increasingly unbalanced remuneration of medical services. So far, so undisputed. However, the tariff partners – namely the health insurance associations, the medical profession and the hospital association – disagree on what a better solution might look like. To put it mildly.
Negotiating partners in the clinch
The legislature’s mandate is clear. It calls for a tariff that enables appropriate remuneration for outpatient medical services. Fulfilling this task, however, has proven to be an impossibility over the past few years. One important reason for this is likely to be the discord between the parties involved. While the FMH, the health insurance association curafutura and the association of accident insurers MTK jointly submitted the proposal for the new TARDOC 2019 rate structure to the Federal Council for the first time, the hospital association H+ has long since left the negotiating table. The second health insurance association, santésuisse, which represents slightly less than half of the insured, is also going its own way and pursuing a different goal with flat rates instead of individual tariffs.
The absence of H+ as well as santésuisse as authoritative contractual partners represents one of the Federal Council’s main points of criticism of the new physician tariff. The latter understandably considers the approval of a collective agreement submitted without the participation of all relevant partners to be “problematic”. However, bringing all the bargaining partners to the table could prove difficult in view of the long history and is likely to lead to further turbulence in the coming years.
TARDOC – what will be better?
Not only the names of TARDOC and TARMED are similar at first glance, but also their structure. In both cases, these are single service tariffs. In contrast to TARMED, however, TARDOC is intended to fairly reflect the range of medical services that are relevant today. Among other things, new items were created not only to accommodate new procedures and technical capabilities, but also to more fairly capture, for example, primary care physician activity. In addition, the chapters have been restructured. In total, the tariff consists of 2693 individual action and time services. Each of these services is assigned to one of 71 thematic chapters. Where available, TARDOC’s rates are based on current data on infrastructure and personnel costs, with TARDOC providing only the rate structure. Service providers and payers negotiate the so-called “tax point value”. The effective price is then based on the tax points of the respective service according to TARDOC, the cost neutrality factor (“external factor”) and the negotiated tax point value. An important innovation compared to TARMED is that TARDOC is to be subject to regular further development. It is to be revised annually, a main task of the tariff organization ats-tms AG. The corresponding legal basis was passed by parliament during the 2021 summer session and obliges the associations of service providers and insurers to set up an organization for the elaboration and further development as well as adaptation and maintenance of the tariff structures.
What now?
With the rejection of the Federal Council, the introduction of TARDOC, originally planned for 2021, has become a distant prospect. In the meantime, FMH, curafutura and MTK are targeting Jan. 1, 2023, for entry into force. Whether this goal is realistic remains to be seen and will probably depend to a large extent on whether a joint solution can be found with the hospital association H+ and santésuisse. In addition, the Federal Council presupposes the assurance of a cost-neutral introduction as well as the improvement of material deficiencies. In particular, he said, the economics of the rate structure need to be revised.
So while the tug-of-war continues and a sustainable solution for appropriate remuneration in the outpatient sector has still not been found, we continue to bill according to TARMED – not only with weighty financial consequences in the healthcare system, but also with the danger of incorrect care due to false incentives. Consider that currently about 12 billion Swiss francs are billed annually via a tariff that has long been outdated. This corresponds to approximately one-third of all benefits provided by mandatory health insurance. In addition, there are the benefits at the expense of the other social insurances (disability, accident and military insurance). Time is pressing and it is to be hoped that not only a quick but also a sustainable solution can be found. And that the new physician tariff – TARDOC or not – does not gather dust on the shelf again, but receives the care and maintenance that make such an instrument dynamic and durable. Hope dies last.
Literature:
- Media release “TARDOC: Federal Council calls on tariff partners for joint revision”. 30.06.2021. Federal Office of Public Health FOPH, Bern.
- Morger M, Müller P: New outpatient tariff structure TARDOC: a necessity. Swiss Medical Journal. 2019; 100(49): 1650-1652.
- TARDOC. www.fmh.ch/themen/ambulante-tarife/tardoc.cfm (last accessed 09/26/2021).
- TARDOC: Tariff for the billing of medical services. https://ats-tms.ch (last accessed 09/26/2021).
- Media release “Physician tariff: Decision of the Federal Council is incomprehensible and not comprehensible”. 01.07.2021. curafutura and FMH, Bern.
InFo ONCOLOGY & HEMATOLOGY 2021; 9(5): 44 (published 10/27-21, ahead of print).
InFo PNEUMOLOGY & ALLERGOLOGY 2021; 3(4): 33.
