Reimbursement Row

I've recently encountered a number of articles questioning the usefulness of comparative effectiveness research. For example, Keith Winstein, writing in the Wall Street Journal Feb. 10, details the failure of medical practice to adapt to findings from the Courage trial — reported to great acclaim in the New England Journal of Medicine in 2007 — about the relative effectiveness of drug therapy and stenting in relieving chronic chest pain.

When pitching to potential life sciences technology investors, entrepreneurs know that they need to demonstrate a clear path to reimbursement. Angels, VCs and strategic partners don't want to commit resources to develop something that won't get adequately paid for in a reasonable timeframe. That makes perfectly good sense. Indeed, I'd argue that the need to assess a technology's likely reimbursement status begins even earlier than the investment pitch.

Nothing is as constant as change, especially at this time of year in the world of coding and reimbursement. For example, are you aware of the following new developments?

• Physician Coding: The American Medical Assn.'s CPT 2010 coding manual was shipped to healthcare providers in October. It contains all the new, revised and deleted Level I codes; Category II (performance measurement) codes and Category III (T codes for emerging technology, services and procedures) that become effective Jan. 1, 2010. Now is the time to become familiar with any changes related to procedures that may involve your products.

While Harry Reid dithers about the final shape of the Senate's reform legislation and industry quivers over the prospect of a federal excise tax on medical devices, some key actors – both public and private – are forging ahead with creative initiatives to control health care costs and improve quality and consumer choice.