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Microinvasive Glaucoma Surgery (MIGS) tariff payments

7 November 2019

The RCOphth is aware of concern from members and industry regarding the current payment arrangements for Microinvasive Glaucoma Surgery (MIGS). Extensive work has been going on behind scenes, working with the ophthalmology Expert Working Group (EWG)1, glaucoma specialists and the RCOphth professional standards team. The national system for coding and tariffs is extremely complex and changing either codes or tariffs takes a considerable amount of time. Additionally the system is affected by a lag of around two years in reflecting real life costs into the tariff payments made to hospitals; also most hospitals get paid more than headline tariff prices as a way of reflecting the true costs of providing care in their individual locality.

An extensive discussion has been held with the National Casemix Office (NCO) surrounding the issue of HRG tariff for MIGS and phaco/MIGS, the issue being the fact that both are reimbursed the same amount of money in 2019/20. There are limited options available to tackle this in as much that the HRG system is almost certain to be rolled over into next year, and there are no new costings currently available to inform tariff, thus no new HRG codes can be generated currently. The NCO was requested by NHSE/I to review the options as to how to differentiate between the two in terms of current HRG grouping. The NCO took EWG advice on this and a majority of the group supported a proposal to move phaco/MIGS from BZ91 A/B Complex, Glaucoma and Iris procedures  to BZ30 A/B Complex Cataract procedures. Whilst imperfect and bearing some risk for the future this is the only currently practical way of differentiating between the two and would increase funding of phaco/MIGS as opposed to MIGS alone. In the long term all these problems will be diminished by new costings from PLICS data and an HRG refresh supported by better coding, but until then this appears to be the best solution available. NHSE/I’s final decision on this is awaited and will be clear at the Section 118 Tariff Consultation Process.

The RCOphth and the EWG are continuing to work actively with the NCO and other stakeholders to agree improved coding that could be used in the near future to identify MIGS and allow it to be separately coded from more traditional tube surgery such as Ahmed or Baerveldt tubes which will help to clarify the real world costs of MIGS and how many are being undertaken across England.

Expert Working Group:  advises NHS England/Improvement on clinical aspects of pricing and costing for ophthalmology