15th Annual Medical Device Coverage and Reimbursement Conference

July 16-17, 2019 | Chicago, IL

Hilton Chicago Magnificent Mile Suites

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DAY ONE | TUESDAY, JULY 16

7:30 REGISTRATION & WELCOME COFFEE

8:15 CHAIRPERSON’S OPENING REMARKS

8:30 OPENING ICE BREAKER: NAVIGATING THE CURRENT REIMBURSEMENT LANDSCAPE FOR MEDICAL DEVICES
When managing reimbursement operations for upcoming and current medical devices, executives are tasked with ensuring optimal coverage for products to ensure that patients have uninterrupted access to medical products. Given trends within the medical device industry, participants are looking for ways to maximize new and current codes, internal & external influencers, and creative approaches to secure reimbursement. This kickoff event will allow executives to participate in and inform one another of valuable insights pertinent to reimbursement in the medical device space. Furthermore, participants in the warm-up session are also given the opportunity to build contacts with industry peers, kicking off the event networking platform.

 

9:00 CMS MAC MEDICAL DIRECTOR PANEL DISCUSSION: EMERGING MATRIX OF MEDICAL DEVICE QUALITY METRICS
The United States Centers for Medicare & Medicaid Services provide health coverage for over 40 million beneficiaries across the country, making CMS the largest payer in the nation, and the most influential decision maker in medical product coverage and reimbursement. Facilitated through regional Medicare Administrative Contractors (MACs), nominated medical directors establish local coverage determinations, confirming the medical necessity of products and procedures in a localized geographic market. Of extreme importance, these influential decision makers will reflect on CMS priorities in the years ahead, and methods of decision making for medical device manufacturers.

  • Impact of CMS policy changes on device coverage
  • Bundled payments & value based care models
  • Reflection of quality at the CMS payer level

PANELISTS:
Arthur Lurvey, MD, FACP, FACE, NORIDIAN HEALTHCARE SOLUTIONS, LLC, FARGO

Robert Kettler MD, WISCONSIN PHYSICIAN SERVICES CORPORATION

Alicia Campbell MD, FIRST COAST SERVICE OPTIONS, INC.

 

10:00 COFFEE AND NETWORKING BREAK

 

10:30-1:45 OPPORTUNITIES IN THE INTEGRATION OF RISKSHARE MODELS TO SUPPORT DEVICE REIMBURSEMENT & ACCESS
The continued transition from volume to value-based healthcare delivery and the focus on higher quality outcomes and reduced expenditure continues to challenge medical device manufacturers, who are responding with creative risk-share agreements that benefit stakeholders throughout the supply chain, including health systems, payers, patients and manufacturers alike. These agreements underscore the value and positive contribution of product outcomes as well as take into account efficiencies in reimbursement created by bundled payments and can be of particular benefit when facilitating the integration of new technologies into the healthcare paradigm.

 

10:30 PAYER CASE STUDY | LEVERAGE OF RISK-SHARE IN CONTRACTING

  • Payer perspective on risk share agreements
  • Review of recent success at the payer level
  • Risks & benefits for payers & manufacturers
  • Creating mutually beneficial agreements

Carlotta Rinke, MD, FACP, MBA, Senior Medical Director, AETNA

 

11:15 MANUFACTURER CASE STUDY | PRESENTATION
OBJECTIVES:

  • Framework of risk share agreements
    • Provider based
    • Payer focused
  • Steps taken in contract negotiation
  • Outcomes gathered from partnership

Max Gill, Senior Director Health Economic, Policy & Reimbursement, MEDTRONIC

 

12:00 LUNCHEON FOR ALL SPEAKERS, SPONSORS & ATTENDEES

 

1:00 LEGAL INTERPRETATION: REDUCING COMPLIANCE THREATS IN RISK-SHARE AGREEMENTS

  • Legal barriers to risk-share agreements
  • Impact of Stark law & Anti-trust on contracts
  • Mitigation of contract compliance risks

Donielle McCutcheon, Partner, SIDLEY AUSTIN LLP

Catherine Starks, Associate, SIDLEY AUSTIN LLP

 

1:45-4:30 OPTIMIZING REIMBURSEMENT: STRATEGIC APPROACHES TO MEDICAL DEVICE CODING
Coding remains a fundamental challenge for device manufacturers in the pursuit and maintenance of market access across today’s healthcare industry, whether working to secure reimbursement within existing coding frameworks, or acquiring a new device code. Despite both AMA’s and CMS’s existing coding frameworks remaining intact and navigable, innovative product iterations and first-in-class technologies leave manufacturers concerned for the viability of device operationalization and market capitalization within the constraints of the current coding parameters.

 

1:45 SECURING REIMBURSEMENT THROUGH USE OF EXISTING CODES

  • Exhaustive analysis of available device codes
    • CPT
    • HCPCS
    • ICD10
  • Balancing value of code against device price
  • Maximizing use of existing available codes

Cyndy Novak, Health Economics Manager, MEDTRONIC

 

2:30 COFFEE AND NETWORKING OPPORTUNITY

 

3:00 OPPORTUNITIES IN ESTABLISHING A NEW DEVICE OR PROCEDURAL CODE

  • Navigating CPT Editorial Panel coding applications
  • Data expectations for new coding submissions
  • Efficiencies in data & document development
  • Lessons learned from successful applications

 

3:45 AMA CPT LITERATURE & EVIDENCE REQUIREMENTS

  • Analysis of CPT literature requirements & updates
  • Optimizing approaches to planning product pipelines
  • Evidence requirements recently approved by the AMA

Zach Hochstetler, Director, CPT Editorial and Regulatory Services
AMERICAN MEDICAL ASSOCIATION

 

4:30 OVERTURNING NEGATIVE MEDICAL DEVICE COVERAGE DECISIONS
Medical device firms in receipt of a negative coverage determination are frequently unsure as to next steps in securing product coverage, and whether there are possibilities of turning around decisions provided by government and commercial payers. Analysis of the process undertaken by one manufacturer in reversing a coverage decision will provide participants with deep insights into remedial steps taken, data generated and provided, as well as practical methods of conveying value messages in a persuasive manner. Additional focus will include proactive, preventative measures that manufacturers can integrate in order to avoid negative coverage decisions.

Jeff Potkul, Global Director- Healthcare Economics, Policy & Reimbursement, MEDTRONIC

 

5:15 END OF DAY ONE CONFERENCE

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