Reimbursement | MassDevice

Healthcare reform is a matter of scale

February 15, 2010 by Edward Berger

Optimal healthcare reform requires reimbursement models matched to providers' organizational capabilities.

I've recently encountered a number of articles questioning the usefulness of comparative effectiveness research. For example, Keith Winstein, writing in the Wall Street Journal Feb. 10, details the failure of medical practice to adapt to findings from the Courage trial — reported to great acclaim in the New England Journal of Medicine in 2007 — about the relative effectiveness of drug therapy and stenting in relieving chronic chest pain.

Clearing a path to reimbursement, Part II

January 24, 2010 by Edward Berger

Demonstrating clinical evidence is the place to begin ensuring that your new medical technology can win reimbursement.

Clearing a path to reimbursement, Part II

If "Do you have a code?" is the wrong question to ask when assessing the reimbursement prospects of an innovative device, drug, or diagnostic, is there a right one — a single question that can separate the life science reimbursement gold from the technological base metals that insurers won't likely pay for? Yes there is, and it's a question I don't often hear asked in a clear and concise way:

"Can you demonstrate, with evidence strong enough to withstand rigorous review, predictable clinical benefits to a defined patient population?"

Stated even more simply: "Can you prove your technology's clinical utility?"

CMS shifts coverage on HIV screening

December 8, 2009 by MassDevice staff

The Centers for Medicare and Medicaid Services will cover annual HIV screening for at-risk individuals and pregnant women, hoping to slow the spread of the virus among older populations.

The Centers for Medicare and Medicaid Services shifted gears on its reimbursement policy for both standard and rapid HIV tests, in an attempt to catch more undiagnosed cases in vulnerable populations.

The national insurer changing a statute to make it easier for people whose behavior puts them at greater risk of contracting the virus to get annual screening.

CMS said it will now reimburse physicians for annual HIV screening for the following populations:

Men who have had sex with men after 1975;
Men and women having unprotected sex with multiple partners;
Past or present injection drug users;

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MassDevice Q&A: Charles Mathews

October 1, 2009 by Brad Perriello

The Boston Healthcare Associates reimbursement expert dishes on the healthcare reform push and how it will affect medical device makers, ahead of his keynote speech at the MassMEDIC 11th Annual Medtech Investors Conference.

Charles Mathews is no stranger to Capital Hill, having worked as a legislative aide to Reps. David Price (D-N.C.) and Rob Andrews (D-N.J) in the early years of the decade. That experience comes in handy in his role a director at Boston Healthcare Associates, where he's keeping tabs on the ever-evolving debate over healthcare reform in Washington.

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CMS announces panel on catheter ablation for treatment of atrial fibrillation

August 17, 2009 by MassDevice staff

Federal health insurer will take up the coverage decision Oct. 21.

The Centers for Medicare & Medicaid Services will hold a hearing Oct. 21 to discuss its coverage policy for radio-frequency catheter ablation techniques to treat atrial fibrillation.

The federal health insurer doesn't have a national coverage policy on the procedure, which involves using high-frequency energy delivered to cardiac tissue through a catheter. The procedure is supposed to neutralize the cardiac cells that cause arrhythmia.

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Healthcare reform and the profit motive

August 3, 2009 by Edward Berger

Spotlight on advanced imaging reimbursement.

Any list of the most important medical technology advances of the past 25 years, or almost any one of those years, would include, very near the top, the development of advanced diagnostic imaging modalities – CT, MRI, PET. Access to precise and detailed images of internal organs and systems has provided an incredible improvement in diagnostic capability, therapy selection and procedure planning and guidance. Capabilities that were unthinkable only a few decades ago are viewed as routine today.

Dr. Obama is in the house

April 21, 2009 by Katie Quackenbush

More than $1 billion from the American Recovery and Reinvestment Act is earmarked for comparative effectiveness research. What will that mean for the Commonwealth's medical device sector?

Suzanne Ryan has a bum knee. If she doesn’t spend most of the day sitting down, she ends up coping with a lot of pain.

Her doctors say there are two options for the semi-retired elementary school teacher: Knee replacement surgery, using state-of-the-art plastic implants, or periodic injections to reduce inflammation and pain and improve joint flexibility.

When MassDevice first speaks with Ryan, in March, she's unsure which offers the best chance of regaining mobility.

"I’m not sure which treatment I’ll choose,” Ryan says. "The device or the drugs."

President Barack Obama wants to help her decide.