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Why reimbursement lags for MR-conditional CRM devices, and what to do about it

October 02, 2019
From the October 2019 issue of HealthCare Business News magazine

By Doug Beinborn

Medical device manufacturers continue to create breakthrough technologies that help physicians provide the best possible outcomes to patients and MR-conditional cardio rhythm management devices are no exception.
Medical advancement is always welcome in the healthcare industry for patients and providers alike. The problem arises when reimbursement lags, penalizing providers for choosing advanced devices that often come at a premium price. Here’s why that happens and what hospitals can do to mitigate the pressure to their budgets.

The heart of the matter
In the past, performing MRs on patients with pacemakers and defibrillators raised concerns about the potential to inhibit pacemaker function, trigger rapid pacing or deliver inappropriate shocks, causing patient harm or damage to device components. This meant a patient with a pacemaker or ICD (implantable cardioverter-defibrillator) undergoing an MR scan needed a physician, nurse practitioner or physician assistant with expertise in the space to adjust programming of the device and to monitor the procedure, creating logistical challenges, as well as additional costs, for staff or hospitals being able to provide MR ability and resorting to different imaging modalities. In addition, for hospital systems that don’t have trained staff to reprogram the devices, manufacturer personnel need to be present to change the settings before and after the procedure. It’s a huge burden on health care.

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Now, there are MR-conditional (compatible) cardio rhythm management (CRM) devices, such as pacemakers and ICDs that have been approved by the Food and Drug Administration (FDA), which enable patients to undergo MR scans without worry of device malfunction or damage. These new devices are still relatively new to the market and offer a high value to patients and physicians.

Manufacturers view their newer technologies, which alleviate the traditional challenges, as premium devices worthy of premium prices. This is where the reimbursement lag begins.

The Centers for Medicare and Medicaid Services (CMS) has not yet created separate payment categories for these improved devices, and assigns them with the same APC (ambulatory payment classification) and DRG (diagnosis-related group) coding as earlier generation MR- non-conditional (incompatible) devices, leaving hospitals to pick up the tab on the extra cost. Because 87% of patients with pacemakers are 65 years of age or older, according to one epidemiological study, CMS is the main payer in this segment of the market.

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