The Aequitas Group
Reimbursement Coverage and Coding Analysis - Vascular Stents
The vascular stent marketplace is highly controlled by governmental and commercial third-party payors. A global healthcare company was required to demonstrate the clinical advantages of their device in order to increase payment levels.
Current Carotid Artery Stenting (CAS) specific DRG codes had corresponding pay rates that failed to adequately capture the technological characteristics of the client’s device, and significant clinical and economic evidence was necessary to demonstrate the advanced clinical utility of the device.
The Aequitas Group demonstrated cost-effectiveness of the device in comparison to carotid endarterectomy (CEA) by determining the incremental cost-effectiveness ratio of each approach, thereby justifying a DRG payment change.
Quality of Life (QoL) changes were measured with validated questionnaires, over a month of post-procedural interval to determine whether patients treated with the device reported greater QoL improvement than those treated by CEA. Costs of the device were compared to established alternatives to justify higher third party payments. Through the design and execution of the economic and QoL study, we were able to support the reimbursement strategy, and a new DRG was obtained.
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