Effectively manage high-cost devices with IPG's Implantable Device ManagementSM


NO DISRUPTION


COST SAVINGS


EASE OF ADMINISTRATION

IPG is a supporting member of AHIP

Payor Solutions: The Factors

The complexity and uncertainty surrounding claims including high-cost implantable devices cause many providers to employ aggressive measures in order to mitigate reimbursement risks. New indications, increasing costs and greater utilization are together creating a larger need for comprehensive solutions for all of the stakeholders in this industry. For commercial payors, there are essentially four barriers to understanding and better managing the challenges as they exist today:

GLOBAL BILLING

Today, Medicare is trending toward globalization where equipment, services and fees are bundled into broad coding categories, but for high-cost implantable devices this does not make sense. The only way to effectively manage a large category like device spend is to be able to measure it and track it separately, something not available in the marketplace until now.


GROWING UTILIZATION

As implantable devices continue to demonstrate positive, measurable outcomes for patients, new indications will be revealed and an upward trend in device utilization will continue. Newly approved technologies and indications (such as Cardiac Resynchronization Therapy [CRT] devices, the most expensive implants to date), costs are expected to increase by nearly 40% over the next three years.

The utilization of implantable devices such as pacemakers, defibrillators, infusion pumps, spinal cord stimulators, orthopedic implants and so on, to treat injuries, chronic illness and disease continues to grow and continues to represent a significant expense to insurance companies, TPA's, health plans and employer groups. Nearly every commercial carrier in the country is in a search for an effective solution.


CONTRACTING STRATEGIES

Due to various pressures, many facilities have had to substantially mark up pricing on device related claims many times over the actual cost to attempt to gain sufficient reimbursement. The contracting strategies of the past did not accurately deal with high-cost implantable devices, nor did they account for the growth in utilization, therefore a better method must be used to better isolate the device portion of related claims.

Specific methods to attempt to address such issues, such as invoice plus pricing, are impossible to administer due to the volume and complexity that surround the procedure.


PLACE OF SERVICE

Finally understand your implant utilization with IPG’s INSIGHT Device Management SystemSM

Many surgeries can be safely performed in an ambulatory surgery center, which can be a more cost effective setting. Physicians will not perform surgeries requiring implants in their centers if the reimbursement does not contemplate the cost of the implant – they simply will not operate if they believe they are not able to make a profit. Many simply disallow the procedures altogether which forces surgeries into more expensive places of service or results in patients seeking other less effective therapies which may also ultimately be more expensive. IPG can provide some interesting data regarding these cost comparisons between treatment regimens. The facility is relieved of the financial burden of the implant, allowing available procedures to be performed in the ambulatory setting, affording the member and the payor a more cost effective solution on both the procedure and the implant.


Many commercial payers are experiencing the effects of all of these factors and now realize that a comprehensive solution is needed.

Go to THE PAYOR CHALLENGE >