In an example of the power of collaboration, the Foundation hosted a Reimbursement Summit on May 13th in Charlottesville. The more than 20 attendees included professionals from Philips Healthcare, InSightec, EDAP-TMS, and reimbursement consulting firm ADVI. The group attained their primary objective to develop an integrated action plan to obtain U.S. reimbursement for focused ultrasound treatment of uterine fibroids and palliation of painful bone metastases.
The meeting agenda included:
- Baseline reviews of the uterine fibroid treatment and reimbursement landscapes
- Baseline review of the medical procedure coding process
- Review of current evidence and gaps in evidence
- Stakeholder mapping and analysis
- Creating the action plans
The Action Plan developed includes key strategies to engage with specialty societies to pursue top category coding (CPT 1) with the AMA for both bone and fibroids. In addition, there are several studies planned to gain the evidence needed for payers to develop positive policies to cover fibroids, including the Philips clinical trial, a retrospective analysis comparing FUS to UAE, and the global registry.
“The existential threat to focused ultrasound is the lack of commercial success for uterine fibroids. It is yet to be globally reimbursed.”—Foundation Chairman Neal F. Kassell, MD