MarketReach
America > Reimbursement
as Part of U.S. Market Entry Strategy for Medical Device & Life
Sciences Companies
On January 15, 2007, The Trendlines Group and
the Maryland/Israel Development Center presented a MarketReach America
seminar sponsored by The Israel Export & International Cooperation Institute.
More than 80 participants attended the Market
Reach America seminar in Tel Aviv at the
Crowne Plaza Hotel.
Lynn
Shapiro Snyder and Robert
Wanerman (medical reimbursement experts
from Epstein Becker & Green)
and Marcia Nusgart (an expert in coding
strategies from Nusgart
Consulting LLC) led the audience into the complex
world of the U.S. health care system.
Download Lynn, Robert, and Marcia's full
presentations from
the Israel Export & International Cooperation Institute.
The definitions. Lynn began with a brief explanation
of the terminology and overall structure of the health care
system. She introduced the three underlying
principles of medical reimbursement in the United States: coverage,
coding, and payment. "Coverage," she said,
"relates to the terms and conditions for payment. Coding
refers to the identifiers for diagnoses and procedures." In
the United States, every procedure and sub-procedure has
a specific code. "Payment is the amount that is reimbursed."
The structure of the U.S. health care system . The
United States has a decentralized
health care system. With some
exceptions, the government does not step in to cover health
care costs. There
are more than 1,200 different health care plans in the States.
U.S. health care payers may be private
or labor unions or others. Businesses in the United States
offer health care packages to employees as an "option." In
fact, there are more than 49 million people in the United
States without health insurance.
Government-funded programs. The
U.S. government supports Medicare for people 65 and older
and the disabled; Medicaid for the poor, indigent seniors,
chronically ill, and women and children; TriCare for military
dependents; and SCHIP for children. Lynn pointed out to the
audience that companies developing products or technologies
related to older women or military dependents would be "winners."
The myth behind FDA approvals. Many
young companies believe that once they get FDA approval,
their device or product will automatically be reimbursed.
"Not exactly," Lynn noted. "Just because
you get FDA approval does not guarantee that you will get
approval from an insurer." The insurers are the ones
who determine the amount of reimbursement, not the FDA.
Dr. Gary Applebaum, chairman of the Maryland
Israel Development Center's Life Sciences Advisory Committee, presented
some extremely useful insights about working with doctors. Applebaum is
a physician who specializes in internal medicine and geriatrics.
1. Doctors are constrained by time. Their time is very short. Their staff protects
and "defends" the doctors' precious time, so be nice to the staff.
2. Doctors work "crazy hours," so when they say are available to meet, you also
need to be available. Be flexible.
3. Doctors don't want to work for free, but they don't like to talk about money. Be straightforward and bring it up.
4. Doctors are generally not risk-takers, nor are they necessarily good investors.
5. Doctors are not technologically savvy. They may understand your product from the medical standpoint but not understand (or care about) the underlying technology.
It is more important to "get in the door first," she
said, "and don't worry about the money you'll make." Talk
to the strategic decision makers. Make sure that you are
telling a very compelling story that emphasizes your unique
difference. In fact, begin the reimbursement strategy early
in the product development cycle. In some cases, it may
be necessary to make design changes so
the product
will receive reimbursement.
Can you say "hick picks"? In a
short overview of coding (later in the day Marcia discussed
coding in greater detail), Lynn introduced the CPT procedures
book, which documents all of the services offered
by doctors. She also discussed HCPCS (pronounced "hick
picks")
codes, which relate to drugs and devices. The
code ties the coverage to the payment. Codes are updated
according to various timetables throughout the year.
Just before the end of her presentation, Lynn reviewed coverage of
Part A (hospital inpatient services), Part B (outpatient
services), and Medicare Part D.
As Lynn stated several times, the reimbursement
concept is complex and intricate, yet vital to any company looking to market
its product in the United States. It is critical to work with professionals who
understand the laws to help you navigate your way.
Your
U.S. market entry strategy checklist
Introducing Lynn Shapiro Snyder Steve Rhodes, chairman, The Trendlines
Group
09:30-10:45
Keys to a successful reimbursement
strategy: Introduction and case studies Lynn Shapiro Snyder, Epstein
Becker & Green (EB&G)
11:00-12:15
Keys to a successful reimbursement strategy
(continued) Lynn Shapiro Snyder Robert Wanerman, EB&G
12:15-12:30
How to recruit U.S. physician champions
and how to use them Dr. Gary Applebaum, chairman, MIDC Life
Science Business Advisory Committee; former chief medical
officer, Erickson Retirement Communities
12:30-12:45
MarketReach America
Life Sciences & Medical
Devices 2007 D. Todd Dollinger, chairman, The Trendlines
Group
13:30-13:45
Life Sciences at the IEICI David Furst
13:45-15:00
Panel discussion: Reimbursement strategies:
Real-life stories MODERATORS
Robert Wanerman (EB&G) Lynn Shapiro Snyder Marcia Nusgart (Nusgart
Consulting, LLC) PARTICIPANTS
Gary Applebaum Daphne Haim-Langford, VP business development, Medingo
Medical Solutions Eyal Lifschitz, CEO and general
partner, Peregrine Ventures Avner Lushi, CEO, MonaLiza Medical Ltd.;
director, Israel Healthcare Ventures Limor Sandach, principal, Evergreen
Venture Partners
15:15-16:15
Coding strategies: Case studies Marcia Nusgart
16:15-17:15
Coverage strategies: Case studies Robert Wanerman
On Tuesday, January 16, the presenters held private
meetings with individuals or companies who attended the
seminar.
About the Sponsors and Presenters
Epstein
Becker & Green (EB&G) is one of the premier
law firms in the United States, with more than 370
lawyers and 11 different offices. The firm is widely
recognized for its expertise in the complexities of
the health care and life sciences fields, and has the
largest health care practice in the United States. Lynn
Shapiro Snyder is the director of EB&G's health
care practice.
The Trendlines Group is Israel's leading marketing consulting firm. Trendlines assists Israeli companies of all sizes in every facet of their business development efforts and market strategies in Israel and abroad.
The Maryland/Israel Development Center (MIDC) is a non-profit organization promoting trade, joint ventures, and investment between Maryland and Israeli businesses and research institutions. The MIDC identifies market and technology opportunities, and introduces Maryland and Israeli executives, entrepreneurs, and investors to each other, so they may negotiate mutually beneficial business agreements and create jobs in both countries.
The Israel Export & International Cooperation Institute (IEICI) promotes Israel's exports, trade relations, joint ventures, and strategic alliances with overseas companies and organizations. The IEICI provides a wide range of export-oriented services to Israeli companies and complementary services to the international business community. It is a supported by more than 2,600 member companies, the private sector, and the government of Israel.
MarketReach
America provides U.S. market entry strategy and business development services
to Israeli businesses through a unique U.S. and Israel-based framework. The program
primes Israeli companies for success in the U.S. market and assists American
companies with their international presence through the development of
strategic partnerships. MarketReach America client companies are competitively
selected.
Marcia Nusgart, president of Nusgart
Consulting LLC, is a Washington, D.C.-based lobbyist for the medical device
industry and executive director for four distinct U.S. medical device organizations.
