To the detriment of patients and at the expense of taxpayers
The professional society for interventional pain management rejects the Tardoc cap
The highly specialized discipline of interventional pain management rejects the cap in the Tardoc medical billing system proposed to the Federal Council by the tariff partners in July. It stands in blatant contradiction to the economically sustainable safeguarding of outpatient patient care. The Swiss Society for Interventional Pain Management (SSIPM) therefore calls for a reassessment of the Tardoc cap based on careful investigations and empirical findings, rather than a knee-jerk reaction at the expense of patients and taxpayers.
The professional society for interventional pain management in Switzerland rejects the cap on billable medical services in the Tardoc medical tariff system in its current form. The intended ceiling of 1,577 tax points does not primarily limit medical income, as proponents claim, but rather diminishes patient well-being and security of care. It also stands in blatant contradiction to the principle formulated by the Federal Council that outpatient treatments are to be preferred over expensive inpatient treatments in hospitals. However, this is exactly what threatens to happen if the cap were introduced: once reached, patients can no longer be treated by private specialists because the resulting costs are not covered. The consequence: patients with acute and chronic pain will have to wait longer for treatment or go to the hospital.
Arbitrary rationing of medically necessary interventions
According to SSIPM’s experience, which aligns with that of other disciplines such as oncology, cardiology, ophthalmology, or gynecology, experienced and efficient physicians reach the upper limit after treating only a few patients per day. The reason is that highly specialized interventions, such as infiltrations, nerve blocks, rhizotomies, etc., are performed and billed in performance minutes according to Tardoc. Performance minutes in the tariff do not necessarily correspond to actual minutes, as they are calculated values. Pain management interventions are imaging-guided and time-consuming – a rigid daily cap on tax points effectively limits the number of possible procedures per day, regardless of actual medical necessity or practice size. The calculation method for the cap used by the legislator is based on a physician’s fictitious working time of an average of 12 hours per day. The problem: it is not actual working time, but a theoretical value in minutes stored in Tardoc for each individual medical service. An experienced physician could therefore treat more patients during their actual working hours, but will no longer be able to do so in the future because they hit the permissible limit after just a few patients. According to SSIPM’s assessment, which matches that of other specialist societies, many practices will therefore have to turn patients away as early as the early afternoon.
Many medical practices are already underfunded today
However, the cap also contributes structurally to a reduction in care in specialized outpatient medicine. The reason for this is that Tardoc tariffs medical services on the one hand, and infrastructure, equipment, and personnel costs on the other. Many highly specialized practices are already suffering from infrastructure reimbursements that do not cover costs, which vary from canton to canton. From an economic perspective, a practice is an SME. If the operation is not sustainably financed, it faces closure. Accordingly, in many practices today, the underfunded infrastructure is effectively cross-financed by the reimbursement of medical services. It is therefore highly populist to generalize and imply that the thousands of specialists in Switzerland earn far too much and bill excessive costs because of a few black sheep. The reality is quite different: according to SSIPM’s experience, the infrastructure of many practices is already underfunded by nearly two-thirds today.
SSIPM supports optimizations and the principle of "outpatient before inpatient"
In principle, SSIPM welcomes the intention to implement measures for efficiency and cost containment in the healthcare system. However, the cap on billable outpatient services, decided in principle by Parliament and negotiated under great pressure by the tariff partners, fundamentally contradicts the principle that patients should preferably be treated as outpatients to relieve the expensive hospital infrastructure funded by taxpayers. This inevitably leads to a reversal of the “outpatient before inpatient” principle: more patients must be turned away in the outpatient sector because they can no longer be treated for economic reasons.
No threat to the high-quality Swiss healthcare system
Together with many other specialist societies, SSIPM therefore urgently calls on the Federal Council not to introduce the cap of 1,577 tax points. Instead, in-depth investigations must first be carried out, taking into account experience and empirical data, to determine whether and in what form and amount a cap is economically sensible and how it can be implemented for highly specialized practices. The new tariff structure must not irreparably damage either the fundamentally proven processes in outpatient patient care or the high-quality Swiss healthcare system.
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