Perspectives on Medical Reimbursement
By JR Associates
Over the years, our consultants have developed strong, productive working relationships with many influential medical and biotech industry associations, including the Medical Device Manufacturers Association (MDMA). One of the highlights of MDMA’s annual events calendar is its Coverage, Reimbursement and Health Policy Conference, where our leaders have participated as featured speakers for more than a decade. This year, the tradition continued.
Marking its 20th anniversary, the 2017 reimbursement forum showcased insights and advice from a broad cross-section of experts, including our President, Judy Rosenbloom and VP Global Health Policy, Jo Ellen Slurzberg – both of whom have been involved with this MDMA event since its inception.
Last year, presentations primarily focused on implications of the shift from volume-based care (fee for service) to value-based reimbursement (fee for value). This year, value remained at the forefront of discussions, but speakers also emphasized the role of preparation in reimbursement success.
DAY ONE:
UNDERSTANDING REIMBURSEMENT CONCEPTS AND REAL-WORLD APPLICATIONS
On the first day, participants explored reimbursement fundamentals, including:
• Key reimbursement terms (such as coverage, coding and payment), and their interrelationships;
• Essential steps in the reimbursement process, and how to succeed in obtaining reimbursement;
• Common business issues and risks to consider when developing a medical device commercialization strategy in today’s complex, fluid healthcare environment.
Next, Judy and Jo Ellen led an interactive session examining real-world cases and scenarios to illustrate how manufacturers can prepare for reimbursement issues and address them effectively. This inspired audience members to share their own experiences demonstrating the importance of evaluating risks/rewards and understanding potential tradeoffs prior to moving forward with any course of action.
Judy and Jo Ellen designed this open exchange of questions, ideas and case studies as a kickstarter exercise to help participants begin applying relevant reimbursement principles and practices to their own products.
DAY TWO:
NARROWING THE GAP BETWEEN REGULATORY AND REIMBURSEMENT
On the second day, sessions looked more closely at how to develop a thoughtful market access strategy related to reimbursement. For example, presentations focused on:
• How medical technology innovators can define and demonstrate value to healthcare providers
• What kind of evidence is sufficient to secure a CPT code and maximize reimbursement in today’s AMA/Relative Value Scale Update (RUC) landscape
• How to secure coverage from CMS
• What payers look for from medical technology companies before granting patient access
• How to navigate critical issues in the global medical technology marketplace
Also, Judy and Jo Ellen took the podium once more – this time in a panel focused on how to narrow the gap between regulatory approval and Medicare coverage. In other words, many device innovators have learned that securing FDA approval for a product does not guarantee reimbursement from CMS or commercial payers. Meanwhile, the delay between regulatory review and reimbursement success has been expanding. The FDA and CMS recognize that this is a legitimate problem and are working to narrow the gap. But how can manufacturers help?
Jo Ellen and Judy were joined in this session by government agency colleagues:
• Rochelle Fink, Sr. Health Science Specialist, CDRH, FDA
• Linda Gousis, J.D., Coverage and Analysis Group at CMS
The panel discussed critical success factors, such as how to foster better collaboration among device companies, regulatory authorities and payers. They also stressed the importance of developing a product strategy that clearly addresses reimbursement – beginning with the clinical development and trial phase. This positions a company to work more effectively with FDA and CMS. It also minimizes the time-to-coverage after FDA clearance or approval.
Are you a medical device innovator? Do you need guidance to prepare a reimbursement strategy and action plan that will help you obtain reimbursement and market access?
• Learn about our comprehensive reimbursement services
• See results we’ve achieved for medical technology clients
• Contact us to discuss your reimbursement questions