Result card

  • LEG12: Is Structured telephone support (STS) for adult patients with chronic heart failure subject to price control?
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Is Structured telephone support (STS) for adult patients with chronic heart failure subject to price control?

Authors: Ingrid Wilbacher, Valentina Prevolnik Rupel

Internal reviewers: Ingrid Rosian

Directive 2004/18/EC of the European Parliament and of the Council of 31 March 2004 on the coordination of procedures for the award of public works contracts, public supply contracts and public service contracts {2} 

Use of the common search results by the project manager for this HTA on STS for chronic heart failure patients:

Galbreath AD, Krasuski RA, Smith B et al. Long term health care and cost outcomes of disease management in a large, randomized, community based population with heart failure. Circulation 2004;110:3518-3526. {35}

Staples P;  Earle W.   The nature of telephone nursing interventions in a heart failure clinic setting.  Canadian Journal of Cardiovascular Nursing.  18(4):27-33, 2008. {36}

STS for adult patients with chronic heart failure might be a subject to price control whenever the services included in STS fall under the public contracting legislation/ reimbursement schemes. This might happen in different degrees, up to various level. In a randomized, controlled clinical trial conducted in the U.S. {Galbreath} disease managers were employed by CorSolutions, Inc, which is an established disease management company and was contracted for the study to carry out the structured telephone support. In such case, the whole service would be contracted and subject to contracting.

Directive 2004/18/EC (11) defines »framework agreement" as an agreement between one or more contracting authorities and one or more economic operators, the purpose of which is to establish the terms governing contracts to be awarded during a given period, in particular with regard to price and, where appropriate, the quantity envisaged.

The criteria on which the contracting authorities base the award of public contracts can be either:

(a) various criteria e.g. quality, price,technical merit, aesthetic and functional characteristics, environmentalcharacteristics, running costs, cost-effectiveness, after-sales service and technical assistance, delivery date and delivery period or period ofcompletion, or

(b) the lowest price only.

[Directive 2004/18/EC, Article 53 1.]

Usually, however, for the STS an additional nurse was used who had access to patient data, carried out the STS, monitored the patient, recorded the symptoms and data and reinforced and adapted the plan of care for the patient. The other medical professions did not get involved in STS directly, only indirectly, through the STS nurse, who coordinated all the activities and services around the patient. No study specifically recorded the (decrease or increase of) workload for other specialists in case a STS nurse was involved in the work {Staples}.

In such cases, the medical personnel reimbursement remains a major concern with a lack of appropriate reimbursement in place in most countries worldwide and as a result less STS is introduced by providers {33}. As usual setting for STS is hospital (after patients are discharged from hospitals) it is to be expected that a specific DRG (or similar) needs to be formed to finance the STS service. As pricing is national level task, the national legislation applies and the only price control would be contracts conducted between the provider and payer in accordance with national health policy. The pricing within DRG system must therefore take into account all national legislation and regulation, like national policy on wages or depreciation. However, when the material costs are built into DRG, again the procedures for the public contracting is important, in case of STS it oculd apply to the telephone lines and various equipment that is given to HF patients to monitor their health status at home (scales, meters for circumference of ankles etc).

 

STS for adult patients with chronic heart failure might be a subject to price control whenever the services included in STS fall under the public contracting legislation/ reimbursement schemes. This might happen in different degrees, up to various level. In a randomized, controlled clinical trial conducted in the U.S. {Galbreath} disease managers were employed by CorSolutions, Inc, which is an established disease management company and was contracted for the study to carry out the structured telephone support. In such case, the whole service would be contracted and subject to contracting.

Directive 2004/18/EC (11) defines »framework agreement" as an agreement between one or more contracting authorities and one or more economic operators, the purpose of which is to establish the terms governing contracts to be awarded during a given period, in particular with regard to price and, where appropriate, the quantity envisaged.

The criteria on which the contracting authorities base the award of public contracts can be either:

(a) various criteria e.g. quality, price,technical merit, aesthetic and functional characteristics, environmentalcharacteristics, running costs, cost-effectiveness, after-sales service and technical assistance, delivery date and delivery period or period ofcompletion, or

(b) the lowest price only.

[Directive 2004/18/EC, Article 53 1.]

Usually, however, for the STS an additional nurse was used who had access to patient data, carried out the STS, monitored the patient, recorded the symptoms and data and reinforced and adapted the plan of care for the patient. The other medical professions did not get involved in STS directly, only indirectly, through the STS nurse, who coordinated all the activities and services around the patient. No study specifically recorded the (decrease or increase of) workload for other specialists in case a STS nurse was involved in the work {Staples}.

In such cases, the medical personnel reimbursement remains a major concern with a lack of appropriate reimbursement in place in most countries worldwide and as a result less STS is introduced by providers {33}. As usual setting for STS is hospital (after patients are discharged from hospitals) it is to be expected that a specific DRG (or similar) needs to be formed to finance the STS service. As pricing is national level task, the national legislation applies and the only price control would be contracts conducted between the provider and payer in accordance with national health policy. The pricing within DRG system must therefore take into account all national legislation and regulation, like national policy on wages or depreciation. However, when the material costs are built into DRG, again the procedures for the public contracting is important, in case of STS it oculd apply to the telephone lines and various equipment that is given to HF patients to monitor their health status at home (scales, meters for circumference of ankles etc).

 

  • Critical
  • Important
  • Optional
Wilbacher I, Rupel V Result Card LEG12 In: Wilbacher I, Rupel V Legal aspects In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 3 October 2022]. Available from: http://corehta.info/ViewCover.aspx?id=305

References