Dear colleagues
The more you prescribe drugs, e.g. in cardiology, the lower will be your regression index calculated by santésuisse! Here you may learn, how the santésuisse regression index is constructed and how you may protect yourself from repayments of your money to santésuisse.
Base Case Scenario
Let us assume that you have 1,000 patients annually and that you charge an average of CHF 850 CHF per patient for diagnostic work ups (without other costs for medication ecc).
Let us also assume that these 1,000 patients have the same number of hospitalizations as all the other cardiologists with whom you are compared by santésuisse in the previous year (we shall get back on this). All the variables in santésuisse’s regression index are assumed to be comparable to your practice, with one exception:
You do not prescribe drugs!
Now you may think that you are at least a cheap doctor who is not at risk of an increased regression index and who is not at risk of having to pay back a part your income to santésuisse. This feeling was correct until 2016 with the old ANOVA index. With the new Regression Index, working since 2017, things are inversed. Formerly cheap doctors have now a very high regression index. Why?
We will gladly do a situation analysis for you. So, your spending is 850’000 CHF per year for the diagnostic work-up of your 1’000 patients. Unfortunately for you, the comparison group has a certain number of cardiologists, who are drug prescribers: Statins, Ezetimibe, PCSK9-inhibitors, Inclisiran, Nitrates, Amiodarone, Diuretics, antihypertensives, Jardiance, Betablockers, new oral Anticoagulants, low-dose Aspirin, Ivabradine and Sildenafil or Entresto. The mix of these prescriptions reduces the groups regression index.
Here is our Base-Case Modelling
We have created a model that allows prescribing cardiologists to derive the santésuisse regression index by subtracting the amount of CHF 377,020 (the sum of all PCG-related reimbursements minus the sum of the annual cost of all drugs you prescribe). For this group, the santésuisse index of 100% is now 472,980 CHF, i.e. 850,000 minus 377,020 CHF. And this is the 100% index that will be applied to your costs. Yes, you intuitively got it right: not good!
Your costs of 850’000 CHF by far outweigh the comparison group. Santésuisse gives you a credit of 30 Index points on your costs, what is left is a fine of 235’126 CHF, because your index is 179.9%! You have to pay santésuisse a fine of 235’126 CHF. Because you do not prescribe drugs!
How can you reduce this fine to zero? Here the story goes on!