Specialty Societies Expanding Influence over Reimbursement Decisions, Say MDMA PanelistsSpecialty Societies Expanding Influence over Reimbursement Decisions, Say MDMA Panelists

Medical specialty societies often play a large role in determining which treatments in their area of expertise deserve reimbursement, especially when the decisions are being made for a private healthcare plan. According to a panel of experts at a recent conference, the influence of such professional associations makes it imperative that device companies cultivate relationships with their leaders and members—but not too cozily.

During the panel discussion, reimbursement consultant Judy Rosenbloom, founder and president of JR Associates (Reseda, CA), explained that healthcare plans are flexing their muscle and taking greater control over the practice of medicine. In turn, the healthcare plans contract with benefits-management companies, assigning them the task of determining issues of medical necessity. Those firms often look to medical specialty societies to help develop appropriateness criteria using evidence-based guidelines.

Rosenbloom and other panelists considered the role of medical specialty societies as part of the 10th annual Medical Device Manufacturers Association Coverage, Reimbursement, and Healthcare Policy Conference, held November 13 in Washington, DC.

“Private payers have asked specialty societies to provide services that impact coverage, coding, and payment,” said Jo Ellen Slurzberg, vice president for reimbursement and healthcare policy at Almyra Inc. (Boxborough, MA). “Many are writing guidelines that serve as a basis for technology assessments and policy guidelines.”

In light of these trends, asked Slurzberg, “How do we make sure that our products can slide into those guidelines, but that the playing field is level?”

Cultivating relationships with the leaders and members of medical specialty societies has become crucial for device companies, said John McInnes, an associate with the law firm of Arnold & Porter LLP (Washington, DC). “Specialty societies can be your advocate, and you ignore them at your peril,” he said.

But such relationships must still be kept within reason. According to McInnes, specialty societies prefer evidence-based medicine, and that will always be the manufacturer's best argument. “But beware of turf battles,” he noted, “especially if your technology interferes with or competes with another specialty.”

Also, he said, it is unreasonable to expect that the societies will take a position endorsing a particular manufacturer's device. What they may endorse is a particular clinical practice.

Device companies should be aware that “each specialty society has a different culture,” said Rosenbloom. “It is best to introduce your company and your device to them in a ‘non-asking' way. Say what your device is about—‘we'd like to let you know what our technology does and the value it can bring to the patient population'—and hope that it sparks interest. Become interested in their education department and advocacy group.”

Manufacturers should also become familiar with any accreditation processes a society runs. “This is not a minor thing,” said Slurzberg. “It's often hugely expensive, and some of these processes have become major revenue generators.” It is imperative that these do not devolve into pay-to-play scenarios or situations where the manufacturers with the deepest pockets automatically get the most support, she said.

According to Rosenbloom, it's also important to recognize that specialty societies may not be particularly transparent, and that their processes for managing accreditation programs may not always seem orderly. “Most societies are overseen by volunteers who, as academics and practitioners, see themselves as advocates for patients and the medical profession,” said Rosenbloom. “Their primary mission is to establish effective standards. Furthermore, don't be surprised if there's no well-oiled machine that aligns easily with your business goals.”

“In general, the lack of transparency is not intentional,” Slurzberg said. “It's because they have grown up too fast.”—Erik Swain, MD&DI

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