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Payment And Health Care Delivery — 2018

Ensuring Access For Patients In Need

The advanced medical technology industry creates life-saving and life-enhancing innovations every day, and Medicare patients are a major beneficiary of these advances. AdvaMed’s Payment and Health Care Delivery department works closely with the Centers for Medicare and Medicaid Services (CMS) to ensure patient access to innovations through appropriate coverage, coding and payment policies – the importance of which is magnified when such policies are replicated by private payers.

Coverage, Coding & Payment

AdvaMed worked with member companies to develop new Board-approved proposals for legislative and administrative changes to the Medicare coverage and payment process, to help make it more predictable and to ensure appropriate access to innovative new diagnostics, treatments and cures from the medical technology industry. During the year, AdvaMed successfully engaged the administration to push for changes and lay the groundwork for CMS improvements.

In October, the administration issued changes to the Local Coverage Determination (LCD) process supported by AdvaMed to achieve increased transparency and accountability, and to significantly improve LCD procedures. These provisions included elements of House-passed legislation as well as requirements of the 21st Century Cures Act advocated by the association. Additionally, the administration indicated its intent to release a proposed rule in March 2019 with improvements to the coverage process for breakthrough and innovative technologies.

During the year, pro-innovation CMS changes advocated by AdvaMed also included agency revisions to the Competitive Bidding program for durable medical equipment, improved payment updates for ambulatory surgery centers through use of the hospital market basket, and reforms to the agency’s process for issuing Level II HCPCS codes. The changes to the coding process respond to our long-standing advocacy efforts and include improved transparency and rationale regarding application decisions, elimination of the three percent volume requirement for devices, and measures improving public input and transparency in HCPCS meetings.

Meanwhile, AdvaMed’s ramp-up of activity in the digital health space achieved several successes, including CMS and American Medical Association action to improve coding for telehealth and remote monitoring services, CMS’s incorporation of telemonitoring costs into home health agency cost reports, and the agency’s move to allow coverage of certain continuous glucose monitors when used in conjunction with smartphone technology.

Supporting Members With Research & Education

In 2018, AdvaMed released a follow-up report by Discern Health proposing quality measure concepts for telehealth services, issued best practice guides for coverage and coding with Avalere Health, and updated national estimates showing that medtech spending dropped to 5.2 percent of national health expenditures. The association also hosted its fourth annual Payment Policy Conference in April, which highlighted the ongoing challenges surrounding adoption of new payment models and implications for device innovation.