Case Study Challenge

Vexim, an organisation providing clinical solutions for minimally invasive procedures for patients suffering from vertebral compression fractures, were keen to review their device pricing and put together a business case for NHS procurement requirements. They requested the support of maxwell stanley to improve their understanding of PbR and tariff reimbursement.

Case Study Approach

Once indications for use and underlying pathologies were determined, alongside their potential treatment methods, our qualified Clinical Coding Auditors assigned appropriate OPCS-4 procedure codes to processes involving the spinal device, as well as produce a detailed rationale to support the assignment.

Our PbR Analysts then assigned appropriate HRGs and associated base tariffs for conventional treatments, classifying them by the indications for use alongside the underlying pathologies, allowing a direct comparison with the spinal device treatment.

Further analysis on the effects of co-morbidities and complications provided Vexim with a complete comparison of the two forms of treatment.

Case Study Outcome

Improved understanding of PbR and tariff reimbursement for conventional and spinal device treatments through:

  • Defined OPCS-4 procedure codes for treatment with medical device
  • HRG assignment for conventional treatments versus spinal device treatment
  • Direct tariff comparisons against conventional treatments
  • Co-morbidity and Complications impact analysis