A leading MedTech company faced limited access to one of its interventional products in a Nordic market. While the procedure was adequately reimbursed for inpatient admissions, reimbursement in day-case settings covered only ~20% of the required cost.
As a result, hospitals were disincentivized to adopt the technology, and purchasing increasingly shifted toward cheaper, lower-quality alternatives from Asian competitors.
The client engaged MTRC to support the development of an application to increase the relevant DRG tariff.
MTRC first assessed the reimbursement landscape by mapping current procedure coding practices, applicable reimbursement tariffs, and the status of the procedure in national clinical guidelines. This review was complemented by benchmarking against approaches used in other Nordic markets.
MTRC then engaged key clinical stakeholders by coordinating introductory meetings with two national centers performing the procedure to align on project objectives and evidence requirements. Physicians at each site agreed to lead the process, including coordinating hospital-level cost data collection and driving submission of the application to the national authorities.
Finally, MTRC developed and compiled a comprehensive tariff increase proposal. The submission included a clear description of the technology and procedure, a synthesis of supporting clinical and health economic evidence, relevant endorsements from clinical guidelines and HTAs across the Nordic region, Europe, and globally, and a detailed cost breakdown comparing inpatient and day-case delivery settings.
The dossier was submitted on time and progressed to review at the NordDRG level the following year. Input was gathered from NordDRG Group members, highlighting variation in clinical practice across countries, including limited procedure uptake in some settings and substitution with lower-cost technologies.
The national DRG authority ultimately implemented changes by establishing a new DRG for the procedure. While the final tariff was set at approximately 50% of the required cost, it represented a substantial improvement over the prior ~20% day-case reimbursement level.
The project strengthened the client’s position as a strategic partner in advancing coding and reimbursement practices in the country.
It also improved the economics of day-case delivery, enabling hospitals to allocate more resources toward the client’s higher-quality product rather than lower-cost alternatives.
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