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2017 Payment And Health Care Delivery

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.

AdvaMed’s Value Initiative 

In May, AdvaMed released MedTech and Diagnostics Value Frameworks detailing a comprehensive approach for assessing the value of medical technologies and diagnostic tests, to help support positive coverage and payment decisions. The frameworks are part of AdvaMed’s broader value initiative to provide stakeholders across the health care spectrum – including patients, providers, payers and innovators – with tools to objectively determine the value of products and the evidence needed to support their use. The product of nearly two years of research and stakeholder engagement, the frameworks focus on four key “value drivers”:  clinical impact, non-clinical patient impact, care delivery economics, and societal impacts.

Coverage, Coding & Payment

As part of AdvaMed’s three-year strategic plan, the Association continued work on the development of legislation to support coverage of Category III codes, to expand access for breakthrough technologies, and ensure that New Technology Add-on Payments and their associated services are covered and paid.

AdvaMed also initiated a new effort with the Board of Directors to develop bold new reforms of the Medicare coverage process to help make it more predictable, and to ensure appropriate access to innovative new diagnostics, treatments and cures from the medical technology industry.

Ongoing challenges surrounding adoption of new payment models and implications for device innovation were also among topics taking center stage at AdvaMed’s 3rd Annual Payment Policy Conference in Baltimore in May.

Research On Gaps In Quality Measurement

In December, AdvaMed released a report by Discern Health outlining gaps in payment model quality measures for treatments and procedures that rely on advanced medical technologies. The study highlights opportunities to improve quality measures for hospitals and physicians participating in new care delivery models, and outlines a number of steps that should be taken by stakeholders – including medtech companies – to help fill quality measure gaps.