Baker Tilly worked with senior leaders of a multi-national circulatory support device company to proactively assess market reimbursement trends and develop strategic positioning and communication strategies to reduce the impact of a proposed reduction in Medicare reimbursement for procedures using the client's product.
The Centers for Medicare & Medicaid Services (CMS) released its proposed Inpatient Prospective Patient Payment System (IPPS) guidelines for the following calendar year, outlining reimbursement and guidelines. The proposed IPPS rule included guidelines for a reduction in the reimbursement rate of procedures in a Diagnosis-Related Group (DRG) that is primarily (i.e., 90%) comprised of procedures utilizing the client’s product. CMS requested public comments on the proposed reduced reimbursement rate, as well as alternative ways to reconsider the DRG reimbursement changes.
Baker Tilly conducted real-world data (RWD) research and analytics to assess the market trends of the client’s product, as well as forecast the economic impact of the proposed CMS rule on the payer market. Utilizing the real-world evidence (RWE) insights generated, a payer-focused letter was developed for CMS in response to the proposed rule affecting the client’s product.
Baker Tilly submitted a response letter to CMS, on behalf of the client, demonstrating the impact of the proposed CMS rule on payers and validated that the best alternative pathway for DRG reimbursement changes is a blended average reimbursement rate. The final IPPS rule published by CMS endorsed Baker Tilly’s recommendation of a blended average rate and specifically referenced the supporting RWE that was generated.
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