ARTICLE SUMMARY:
The complexity of the reimbursement process makes when and how to select a consultant a critical part of a company’s overall strategy. This discussion from our recent San Francisco Innovation Summit features perspectives from both companies and a consultant on the best way to achieve this goal and, perhaps more importantly, what pitfalls to avoid.
Ask medtech executives and investors to name the biggest change in the challenges facing device companies today compared with a decade ago and the overwhelming consensus response is that reimbursement has replaced regulatory as the biggest obstacle to successful commercialization. Dealing with the multiple elements of reimbursement—coding, coverage, and payment—which involve a variety of public and private organizations, including CMS, the MACs (Medicare Administrative Contractors, several of which are also private insurers), and the AMA, is generally beyond the capabilities of even large companies to effectively handle in-house, making using an outside consultant an essential part of the process.
MedTech Strategist’s recent San Francisco Innovation Summit, held in November 2021, featured a reimbursement panel devoted in part to a discussion (excerpted here) of when and how a company should look to begin working with a consultant, what to look for in this process, and, as importantly, what potential obstacles to avoid. Rather than talking in hypothetical terms, the panel featured perspectives from two companies with innovative cardiovascular technologies that have successfully navigated the reimbursement process, and an experienced consultant who has worked with many device companies to achieve payment for their products.
