12th Annual Coverage, Reimbursement and Health Policy Conference

Date:

Mon, 11/09/2009 - 8:00am - Tue, 11/10/2009 - 5:00pm

2009 Reimbursement Conference Summary and Highlights

On November 9th and 10th, the Medical Device Manufacturers Association (MDMA) held its 12th Annual Coverage, Reimbursement, and Health Policy Conference in Washington, DC. The Conference presented a unique opportunity for attendees to interact with leading stakeholders and decision makers in the reimbursement arena. Participants were treated to in-depth presentations on basic Medicare reimbursement concepts, the international reimbursement landscape, the role of medical directors, coding concerns, and the role of private payers of medical devices.

The conference began on the afternoon of November 9th with a session on Reimbursement Basics and Strategy. Patty Telgener, Senior Reimbursement Director at Emerson Consultants, presented a comprehensive overview of reimbursement basic principles, including coding, coverage and payment for medical technologies. Ron Podraza of Reimbursement Principles, Inc. touched on important issues for medical device companies in attempting to attract venture capital, including answering many attendee questions about what federal reimbursement decisions mean for moving forward with an investment plan.

The session concluded with an interactive session of case study examples. With the guidance of reimbursement expert moderators, attendees reviewed, analyzed and planned a reimbursement strategy based on hypothetical reimbursement case studies.

On November 10th, the conference began with an overview of the Medicare inpatient and outpatient prospective payment systems. On hand to discuss recent changes were Marc Hartstein, Deputy Director of the Hospital and Ambulatory Policy Group, Center for Medicare Management at CMS, and Carrie Bullock, an Analyst in the Hospital and Ambulatory Policy Group, Division of Outpatient Care.

Conference attendees also heard from leading experts in the commercial payment market. Barbara Grenell, President of Preferred Health Strategies, presented a comprehensive overview, the session then transitioned to a panel discussion of medical directors who provided keen insight of what medical directors take into account when deciding on new technologies.

In light of the upcoming transition to the ICD-10 coding system, Pat Brooks with CMS, discussed the implications of the new coding system for device manufacturers and how the CMS is preparing for the transition. The session concluded with Judy Rosenbloom, President of JR Associates discussing the CPT coding process and challenges device companies face throughout the process.

The afternoon sessions began with a discussion of reimbursement advocacy strategies. The session commenced with Scott Reid, Director, Health Policy and Payment at Boston Scientific Corporation. Reid discussed the multi-tiered approach that a medical device company utilizes in successfully obtaining reimbursement. Edward Dougherty, Senior Vice President at B & D Consulting presented how companies can employ the use of clinical and evidence-based data in their reimbursement advocacy efforts. The session concluded with a discussion by Randel Richner, President of the Neocure Group. Richner highlighted the importance of working with medical specialty societies and how it fits into a successful advocacy campaign.

The International Session involved multiple discussions on utilizing an appropriate international reimbursement strategy. Jo Ellen Slurzberg, Vice President of Reimbursement and Health Policy at Guided Delivery Systems discussed commercialization and reimbursement challenges in health systems within the EU. The session concluded with Stephen Hull, Principal and Founder of Hull Associates who discussed how device companies can utilize their resources to successfully gain reimbursement in numerous health systems throughout the EU and the Asia-Pacific region.

The conference concluded with presentations by Dr. Steve Phurrough, Medical Officer at the Center for Outcomes and Effectiveness at AHRQ and Sean Tunis MD, Founder and Director of the Center for Medical Technology Policy. The ensuing discussion by the panel, moderated by Michael Gaba of Holland and Knight, highlighted how forthcoming federal comparative effectiveness programs may impact the reimbursement of medical technologies

Agenda

Monday, November 9, 2009

2:00 - 5:30 pm

Reimbursement Basics and Strategy

The Reimbursement Basics session will provide an unique, interactive experience for participants developing a reimbursement plan for their company. Learn the basics of the reimbursement process and how to develop a reimbursement strategy. In addition, participants will be able to work on hypothetical case examples utilizing lessons learned from the instructive sessions.

Ron Podraza, CEO, Reimbursement Principles
Patty Telgener, Senior Reimbursement Director, Emerson Consultants, Inc.

5:30 - 6:45 pm

Networking Reception, John Adams Room

Tuesday, November 10, 2009

8:00 - 8:15 am

Registration and Continental Breakfast

8:15 - 8:30 am

Welcome and Opening Remarks

Thomas Novelli, Director of Federal Affairs, MDMA

8:30 - 9:30 am

CMS Update on Coverage and Prospective Payment Systems

The panel of CMS staff will give an overview of recent changes to the Medicare inpatient and outpatient prospective payment systems.

Marc Hartstein, Deputy Director, Hospital and Ambulatory Policy Group, Center for Medicare Management, CMS
Carrie Bullock, Analyst, Hospital and Ambulatory Policy Group, Division of Outpatient Care, Center for Medicare Management, CMS
Moderator: Don Romano, Partner, Arent Fox PLLC

9:30 -11:15 am

Private Payer Questions: Current Trends and the Medical Director's Perspective

Device companies seeking private insurance reimbursement often face unique challenges apart from public reimbursement. Hear first hand experience from several former medical directors charged with assessing emerging medical technologies.

Current Trends in the Commercial Market

Barbara Grenell, President, Preferred Health Strategies

Medical Director's Perspective

Fredrik P. Tolin MD, Medical Director, Chicago Commercial Market, Humana
Jennifer Chambers MD, Medical Director, Capital Blue Cross
Fiona Wilmot MD, Medical Director, Argenta TEC Advisors
Moderator: Brent O'Connell MD, Chief Medical Officer, Argenta TEC Advisors

11:15 - 11:30 am

Networking Break

11:30 - 12:30 pm

The Coding Process: Changes and Challenges

More innovative medical technologies are facing difficulties acquiring the appropriate CPT codes for their technologies. In addition, the Centers for Medicare and Medicaid Services recently announced a transition to the ICD-10 coding system. The Coding Process panel will examine challenges and opportunities in the CPT process and update attendees about CMS's forthcoming transition to the ICD-10 coding system.

Pat Brooks, Senior Technical Advisory, Hospital and Ambulatory Policy Group, CMS
Judy Rosenbloom, Founder & President, JR Associates

12:30 - 1:30 pm

Luncheon: Health Care Reform, John Adams Room

Health Care Reform 2009: Impact on the Device Industry -- With great uncertainty about the future of health care reform, what will be the likely impact on the device industry? Discussion of several key topics likely to affect the device industry including increased transparency and payment reform.

1:30 - 2:30 pm

Reimbursement Advocacy: Multiple Avenues to Success

Securing adequate reimbursement successfully is often a multi-pronged approach. Hear advice on how to successfully secure reimbursement for your technology, from working with specialty societies to advocating before CMS.

Scott Reid, Director, Health Policy and Payment, Boston Scientific Corporation
Edward Dougherty, Senior Vice President, B & D Consulting
Randel Richner, President, Neocure Group

2:30 - 3:15 pm

Developing an International Reimbursement Strategy

With more reimbursement opportunities outside the U.S., what constitutes a successful reimbursement strategy? Panelists will discuss this question as well as other current international reimbursement trends.

Jo Ellen Slurzberg, Vice President Reimbursement and Health Policy, Guided Delivery Systems
Stephen Hull, Principal and Founder, Hull Associates

3:15 - 3:30 pm