Surgical robot medical insurance pricing bureau: return to clinical value, not pay for surgical planning

The 21st Century Economic Herald reporter Wei Xiao reported that the Hunan Provincial Medical Insurance Bureau recently issued the "Notice on Regulating the use and charging behavior of regulating surgical robot auxiliary operating systems".

Specifically, the documents issued by the Hunan Provincial Medical Insurance Bureau are basically consistent with the charges of orthopedic robots released by the State Medical Insurance Bureau before, and they are not paid for surgical planning; they can be paid for navigation. 300%.

A VC concerned to the 21st Century Economic Herald reporters pointed out that the document regulates the pricing problem of surgical robots. Previously, the State Medical Insurance Bureau also gave a quotation of price limit on orthopedic robots. Return to clinical value.

At present, the clinical value provided by domestic surgical robots does not seem to match its high charges. The document may promote the reduction of the cost by limiting the price, squeeze out a certain "pseudo -innovation" to pay for the surgical robot that really has clinical value.

What is the charging standard?

What is surgical robot? It is reported that surgical robots are an advanced medical equipment that consists of three parts: robotic arm, console, and three -dimensional imaging system. It can perform complex surgery in a minimally invasive manner.

The three -dimensional imaging system can clearly amplify the diseased parts to increase the accuracy of surgery; the human arm will tremble, the doctor will be nervous and fatigue, and the robotic arm will not; the human arm rotation angle is limited, and the rotation angle of the robotic arm is more free. Therefore, surgical robots can perform surgery through smaller wounds (minimally invasive), reducing blood loss, which is conducive to patient recovery.

Depending on the type of surgery, surgical robots can be subdivided into laparoscopic robots, orthopedic surgery robots, blood vessel surgery robots, natural lacquered endoscopy robots, and mixture of percutaneous puncture surgery robots.

On March 1st this year, the National Medical Insurance Bureau issued a related price guidance document. The core content is about the price of orthopedic surgery robots and the price of 3D printed guidelines.

The document pointed out that first, any surgical planning product does not set up a fee, including the AR.VR. hybrid reality; second, if it is used as a navigation, or auxiliary surgical effects, you can use surgical fees to pay the fee; Third, the proportion of robots for navigation is not more than 40%, and 2,000 yuan is capped. The robot participating in the surgical steps can be closed by 80%. Increase fees include all consumables.

The document clearly mentions that the purpose is not to affect the effect of joint collection, and the price positioning must be reasonable.

It is worth noting that the documents issued by the Hunan Provincial Medical Insurance Bureau not only have orthopedics, but also cover the operation of head and neck surgery, thoracic surgery, cardiac surgery, general surgery, urology, vascular surgery, gynecological surgery operations.

In terms of charging methods, the Hunan Provincial Medical Insurance Bureau proposed that the auxiliary operation was uniformly charged as the "increase" of the surgical price project. Put a certain percentage of the benchmark price of the surgical items. Adding standards include navigation positioning tool packs (including but not limited to base, tracker, connectors, calibration, guidance pipes, sleeve, fixed device, etc.) and other consumable costs consumed during the use of the "surgical robot".

But surgery planning must not be charged. The document pointed out that the surgical robot auxiliary operating system only exerts the surgical planning function, including but not limited to the application of various digital, visual or intelligent innovative universal technologies such as artificial intelligence, augmented reality, hybrid reality, holographic image, and naked eye 3D. Surgical planning and pre -surgery simulation, etc., the auxiliary operation value is reflected in the surgical price, and no separate charges are performed.

If the surgical robot auxiliary operating system only has and exerts the navigation positioning function, each surgery will be closed by 40%, and the core surgery price is more than 5,000 yuan per case, and the additional standards are capped at 2,000 yuan each time.

Surgical robot auxiliary operating system belongs to the "auxiliary surgical equipment and auxiliary surgical system using robot technology" (referred to as RA equipment/system, including but not limited to surgical equipment control systems such as "Da Vinci Surgical Robot"), according to the corresponding surgical items performed according to the corresponding surgical items Add. If the core operation steps are completed, 80%will be closed; if all the core operation steps are completed, 300%will be closed. It is worth noting that 80%and 300%are selected one and cannot be superimposed.

Generally speaking, the documents released by the Hunan Provincial Medical Insurance Bureau are basically consistent with the cases of orthopedic robots released by the State Medical Insurance Bureau before. All kinds of technologies) paid, can be partially paid for navigation, charged 40%, and capped 2,000 yuan; they can be paid for the core steps of the surgery, which can be paid by 300%, but these 300%include all tool packages and consumables.

"Promoting pricing returns clinical value"

Unlike ordinary medical equipment, the unit price of surgical robots is very high. Taking the Da Vinci surgery robot of the intuitive surgery company as an example, its income mainly includes three parts: system (ie whole machine), services and consumables.

According to statistics from Zhejiang Business Securities, according to the system models, configurations and regions, the price of a Da Vinci surgical robot is between 500,000 and US $ 2.5 million; the annual annual fee of related maintenance and doctors training services is 80,000 to 19 Between 10,000 dollars.

The robotic arm of the Da Vinci surgery robot is a high -value consumable. The surgery requires 4 robotic arm, but each robotic arm can only be used up to 10 times. After that, the robot will automatically lock. The new robotic arm must be replaced. In order to restart, the price of each robotic arm is about $ 2,000. It can be seen that the average cost of surgery robots is expensive at a time. High costs lead to higher medical services related to surgery robots. However, the dispute is that the clinical value provided by the current surgical robot matches its high charges.

According to relevant information, the effects of laparoscopic laparoscopic surgery are not very different from the current laparoscopic robotic robotic robots. The main solution is only the problem of "stable", but the fee is extremely high, which is not very "valuable".

This may also be the reason why related domestic enterprises are more difficult to commercialize. Different from foreign companies, domestic surgical robot companies are still in the early stage of development, and commercialization is more difficult. The revenue of minimally invasive robots in the first half of 2022 was 1.048 million yuan, and shareholders should account for 459 million yuan, an increase of 89.7%year -on -year; Tianzhihang achieved operating income of 60.945 million yuan in the first half of the year, a year -on -year decrease of 20.23%, and a net loss of 44.1785 million yuan. Expand 14.14%.

This file is limited to a certain impact on the domestic surgical robot industry. Some people in the industry pointed out that the above documents are relatively clearly defined with charging problems, that is, surgical planning products cannot be charged; surgical navigation products can be partially charged; surgical robot core products can be charged 300%, but contain all tool packages and consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, or consumables, they can It can only cover the cost. Compared with the previously can charge 20,000 to 40,000, compared with the cost of consumables, the gap is huge.

However, some experts have pointed out that although the documents do not pay for surgical planning, they also reveal that they are willing to pay for clinical value machines. For example, if all the core operation steps are completed, the surgical robot charges can be charged up to 300%. "On the whole, this can be squeezed out of a certain 'pseudo -innovation' from high -tech barriers to pay for high -value and squeeze the virtual high water of low -value surgery robots."

A VC concerned to the 21st Century Economic Herald reporters pointed out that the document regulates the pricing problem of surgical robots. Previously, the State Medical Insurance Bureau also gave a quotable price limit on orthopedic robots. This may reflect a trend that surgical robot pricing Back to clinical value.

In fact, enterprises to create more clinical value at as low as possible. "If surgery robots can really provide intelligent full -process solutions and truly solve clinical pain points, it is naturally not afraid of no market."

- END -