Reimbursement Report -- Available for download
BY KAREN FEDER, JUNE 8, 2005
February 2010 update: This report is no longer available for purchase. Learn more here.
Reimbursement is one of those issues you might wish would go away. Bureaucratic, jargon-heavy, inefficient, not easy to learn, and mostly boring.
For everyone who knows that it can't be ignored -- because 90% of device revenue flows through the system, and the rules are changing big-time -- we wrote our Orthopedic Reimbursement 2005 report.
It introduces you to the orthopedic reimbursement process and the key actors, the trends that pressure reimbursement levels, and recent reactions by hospitals, surgeons, and payers.
- Learn the 10-year history of reimbursement fees for each class of device.
- Find out how a filing a 510(k) with the FDA might limit product revenues.
- How is gainsharing going to affect orthopedic device revenue?
- LMRP and NCD coverage rulings: how they're different, and why you should care.
- Find out why all three orthopedic add-on payment requests for 2006 were turned down.
- Learn the top four methods hospitals use to spend less on implants.
Reimbursement has become a high-stakes battleground issue between device manufacturers and hospitals. Get familiar with the process, and you can make your best business decisions on products.
It's available for $179 at our Reports store.
Table of Contents
Introduction to Reimbursement
Why Reimbursement Matters
About this Report
Section I: The Process
Getting Started - The Basic Elements
Reimbursement's Role in the Product Development Process
Product Strategy Development
The Flavors of Food and Drug Administration Approval
Comparing the PMA and the 510(k) Regulatory Pathways
When to Run Clinical Trials
About Centers for Medicare & Medicaid Services (CMS)
Carriers and Coverage
Differences in National and Local Coverage
Opening The Kimono of the NCD Process
FDA and CMS Working Together
Payment and DRG's
Recent IPPS Developments Related to Orthopedic Procedures
Proposed DRG Code Change: Joint Replacement
Proposed DRG Code Change: Spine Procedures
Add-on Payments
SECTION II: Trends
Factors Affecting Medicare Reimbursement
Changing Demographics
Increased Healthcare Spending
Legislative Activity
Device Costs
SECTION III: Reactions
Hospitals Managing Expenses
Cost Shifting
Capping Prices and Standardizing Products
Educating Surgeons about costs
Exploring Gainsharing
Surgeons' Revenue under Investigation
Diagrams
Payer mix for overall orthopedic procedures (2002)
Payer mix for common joint replacement, trauma & spinal procedures (2002)
Seven Steps of Product Development
Reimbursement fees for key orthopedic procedures
Estimated Number of Medicare beneficiaries: 2000-2030 (millions)
Estimated Medicare spending as % of GDP
Implant prices and Medicare payments to hospitals & physicians on
orthopedic
procedures - DRG 20916
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