In its judgment, the Federal Administrative Court (the Court) dismissed the appeal of 40 health insurers, represented by tarifsuisse ag (now santéservices ag), against the SwissDRG base rates set for the hospitals of Asana Gruppe AG in Leuggern and Menziken for 2018 and 2019. At issue was whether the base rates had to be reduced below the reference value because the hospitals' lower costs resulted from a favourable patient mix rather than from efficiency.

The Government Council of the Canton of Aargau had set a reference value of CHF 9’624.00, based on the 30^th (2018) and 28^th (2019) percentile of a nationwide benchmarking. As the hospitals had concluded tariff agreements with other insurers at CHF 9’590.00, it had set the base rate at this amount. The hospitals' severity-adjusted case costs had ranged between CHF 8’951.00 and CHF 9’420.00. The insurers argued that the hospitals had to prove that their lower costs resulted from efficiency. They relied on the share of profitable cases, below-average lengths of stay, and patient clinical complexity levels (PCCL).

The Court confirmed its case law that efficiency gains were permissible. Lower costs alone did not justify a tariff reduction, as they could result either from efficiency or from less resource-intensive cases. A downward differentiation required concrete indications that a hospital systematically treated simpler cases which the tariff structure did not adequately reflect, resulting in excessive remuneration. None of the insurers' indicators met this threshold. The ratio of profitable to deficit cases did not reveal the underlying causes, below-average lengths of stay could equally reflect efficient organisation, and the PCCL differences were, by the insurers' own admission, not conspicuous. Moreover, the tariff structure already accounted for length of stay and PCCL.

The Court disregarded new analyses submitted only on appeal, as the insurers could have presented them in the cantonal proceedings. It also rejected the request for production of case cost data, as such data could not by themselves provide the required indications.

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