Perspective | Risk Prevention for MDT (Multidisciplinary Team) Fee Collection
Published:
2025-12-31
The term “multidisciplinary consultation” is translated from “Multidisciplinary Team (MDT).” Different domestic documents use slightly varying terms to refer to MDT. For example, the “National Technical Specifications for Medical Service Items (2023 Edition)” translates it as “multidisciplinary outpatient consultation,” while “China’s Hospital Quality and Safety Management—Parts 3–6: Medical Assurance—Multidisciplinary Joint Diagnosis and Treatment (MDT)” uses the term “multidisciplinary joint diagnosis and treatment.” The “Guidelines for the Organization and Implementation of MDT (First Edition)” translates it as “multidisciplinary comprehensive diagnosis and treatment,” and the “Price List for Medical Service Items in Public Medical Institutions of Shandong Province (2023 Edition)” refers to it as “multidisciplinary consultation.” Although these documents employ different translations, their definitions of the concept remain largely consistent: for patients with difficult or complex diseases, two or more experts from related disciplines jointly examine the patient, thoroughly inquire about the patient’s medical history, review laboratory and imaging data, discuss and analyze the condition, conduct a comprehensive assessment of the patient’s situation, and determine the optimal integrated treatment plan.
I. Basic Concepts
The term "multidisciplinary consultation" is translated from "Multidisciplinary Team (MDT)." Different domestic documents use slightly varying terms to refer to MDT. For example, the "National Technical Specifications for Medical Service Projects (2023)" translates it as: Multidisciplinary outpatient consultation “China Hospital Quality and Safety Management, Parts 3–6: Medical Care—Multidisciplinary Team (MDT) Collaboration” is translated as “Multidisciplinary Team (MDT) Collaboration.” The “Guidelines for the Organization and Implementation of MDT” (1st Edition) is translated as: Multidisciplinary comprehensive treatment The “Price List for Medical Service Items of Public Medical Institutions in Shandong Province (2023 Edition)” refers to this as multidisciplinary consultation. Although different documents use varying translations, the underlying definition remains essentially consistent: for patients with difficult and complex diseases, experts from two or more related disciplines jointly examine the patient, thoroughly inquire about the patient’s medical history, review laboratory and imaging data, discuss and analyze the condition, conduct a comprehensive assessment of the patient’s illness, and determine the optimal integrated treatment plan.
Due to the relatively high fee standards for MDT programs, irregularities in medical institutions' billing practices frequently occur, making these institutions particularly vulnerable to improper use of medical insurance funds. As such, they are a key focus of medical insurance audits. Therefore, when conducting MDT services, medical institutions must strictly adhere to relevant regulations to avoid being found guilty of improper use of medical insurance funds.
II. Precautions
When charging fees for MDT projects, medical institutions commonly encounter the following issues:
(1) MDT and In-hospital diagnosis and consultation Confusion
According to the "Technical Specifications for National Medical Service Items" (2023 Edition), an intrahospital consultation refers to a medical consultation among clinicians, pharmacists, nutritionists, and other healthcare professionals from different departments within the hospital, conducted when required by the patient’s condition. Such consultations involve examining patients, analyzing their conditions, and developing diagnostic and treatment plans. Both intrahospital consultations and multidisciplinary team (MDT) meetings involve physicians from different departments collaborating on a patient’s treatment; their fees typically cover activities such as medical history taking, physical examinations, general physical assessments, review and analysis of test results, and prescribing medical orders (including treatment plans and examination/inspection reports). Although these two types of consultations share many similarities in terms of format, their fee structures differ significantly. Medical institutions must pay close attention to strictly distinguishing between the two when setting charges, so as to avoid being accused of illegal use of medical insurance funds through practices such as misclassifying or substituting medical services.
Currently, there are no regulatory documents that clearly distinguish between MDT and in-hospital consultation and clinical conferences. In-hospital consultations are “point-to-point” real-time consultations, whereas MDT is a “many-to-one” team-based collaboration. Based on the characteristics of these two approaches, the author has summarized two key differences:
1. MDT procedures are more complex than in-hospital consultation and multidisciplinary team meetings. The purposes and core outputs of these two approaches differ: In-hospital consultations aim to address specific, localized, cross-specialty issues that arise during the course of diagnosis and treatment; their output is a consultative opinion tailored specifically to the issue at hand. In contrast, MDT aims to develop a comprehensive, sequential, and holistic treatment plan for complex diseases; its output is a consolidated treatment plan reached through team consensus. This fundamental difference gives rise to the following distinctions in terms of process and eligibility criteria. First, in-hospital consultations can be conducted by physicians, pharmacists, and nutritionists, whereas MDTs, in principle, should consist of a fixed team of qualified specialists—typically deputy chief (or senior) physicians and above. Second, in-hospital consultations typically involve only routine examinations and interviews focused on the patient’s current symptoms, while MDTs require the expert team to systematically review the patient’s medical history, perform physical examinations, and engage in intensive discussions about the patient’s condition during regular, specialized disease-specific meetings. Finally, after completing the necessary examinations, in-hospital consultations can directly proceed to analyze the patient’s condition, propose treatment plans, and issue prescription orders. By contrast, after completing the examinations, MDTs must still carry out a comprehensive assessment, thoroughly discuss and analyze the patient’s condition, establish a definitive diagnosis, and then formulate a comprehensive treatment plan.
2. The scope of fees for MDT services is limited to multidisciplinary diagnostic and therapeutic services approved by the national health authority; however, in-hospital consultations and clinical conferences are not subject to this restriction. According to Article 3(1) of the “Action Plan for Further Improving Medical Services (2018-2020),” medical institutions may establish multidisciplinary outpatient clinics for conditions such as tumors, rare and complex diseases, and multi-system and multi-organ disorders. With regard to the scope of rare and complex diseases, medical institutions may refer to the lists of critical and severe diseases specified in documents such as “Guo Wei Ban Yi Han [2022] No. 344” and “Guo Zhong Yi Zong He Bing Han [2024] No. 123.” They must not arbitrarily expand the list of rare and complex diseases. Otherwise, even if the operational procedures comply with the relevant MDT regulations, the institution could still be deemed to have improperly substituted medical services or exceeded the scope of coverage allowed under the medical insurance fund.
(2) Is MDT limited to outpatient reimbursement?
In the "National Technical Specifications for Medical Service Items," MDT is referred to as multidisciplinary outpatient consultation, and this same name is used in our city's catalog of medical service items. Therefore, if a medical institution conducts MDT for hospitalized patients, does this constitute using medical insurance funds beyond the scope permitted by the medical insurance regulations? The author believes that this should not be interpreted in that way.
First, although Document No. 9 [2024] of the Jiyi Medical Insurance Bureau rebranded this project as “Multidisciplinary Outpatient Consultation,” its essence remains: “For patients with difficult and complex diseases, experts from two or more related disciplines jointly examine the patient, analyze the condition, and develop a comprehensive diagnostic and treatment plan. A relatively stable team of experts is formed to hold regular, scheduled meetings at designated locations, providing appropriate and integrated medical advice for a specific disease. The team conducts detailed inquiries into the patient’s medical history, reviews laboratory and imaging data, discusses and analyzes the condition, performs a comprehensive assessment of the patient’s state, and determines the optimal, integrated, sequential treatment plan.” This regulation does not emphasize that MDT must be conducted exclusively in outpatient settings; therefore, conducting MDT for hospitalized patients should not be considered an overuse of medical insurance funds beyond the scope of coverage.
Second, according to Document No. 10 [2025] of the Jiyi Medical Insurance Administration, although MDT is designated as multidisciplinary outpatient consultation, the project mapping table clearly indicates that this project corresponds to item 011106000010000 in the “Guidelines for the Establishment of Comprehensive Diagnostic and Treatment Service Price Items (Trial)” compiled by the National Healthcare Security Administration. Multidisciplinary Treatment Fee The document explicitly states that the service output of MDT is “during outpatient and inpatient visits, with the patient’s informed consent, for difficult and complex diseases, a working group composed of experts—each holding the qualification of associate chief physician (or higher)—from two or more relevant clinical disciplines jointly conducts medical history taking, comprehensive assessment, analysis, and diagnosis of the patient’s condition, and develops a comprehensive treatment plan.” Meanwhile, the pricing guidelines for this project also clearly stipulate that “the duration of each outpatient consultation shall be no less than 20 minutes, and the duration of each inpatient consultation shall be no less than 30 minutes.” Thus, it is evident that conducting MDT for inpatients complies with our city’s medical insurance reimbursement regulations.
III. Standardized Construction of MDT
Medical institutions should standardize their MDT procedures to avoid being identified by the administrative authorities of the medical insurance fund as engaging in illegal use of the medical insurance fund.
First, regarding organizational structure standards: For in-hospital consultations, only the attending physician needs to submit a request to the department involved in the consultation. Typically, that department will designate a single physician to conduct the consultation. In contrast, for MDTs, a dedicated management department should be established. Each MDT team, in addition to the requesting physician, should also include a chief expert, core experts, and a team secretary, and all relevant personnel should be registered and managed accordingly.
Second, process management must be standardized. For in-hospital consultations, the attending physician can directly request a consultation from the relevant department. In contrast, MDT consultations require the following steps: the attending physician assesses the patient’s condition and submits a request; the MDT team secretary organizes and reviews the cases that have been approved; the MDT team conducts a thorough discussion of the patient’s condition; the requesting physician implements the treatment plan; and finally, the patient provides feedback on the effectiveness of the treatment. Medical institutions should ensure that complete records of each step are carefully preserved.
Finally, the consultation records must comply with standardized procedures. Even when an in-hospital consultation involves multiple departments, the attending physician communicates individually with each department, and a separate “Consultation Record Form” is prepared for each communication. The MDT consists of a team of specialists who are either fixed or relatively stable; at each consultation, the MDT collectively prepares documents such as the “Multidisciplinary Treatment Discussion Record” and the “Treatment Assessment Record.”
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