Quorum analyzes historical Medicare claims data to evaluate market opportunities and third-party payer reimbursement.
Business Challenge
The advent of wireless and mobile technological innovations has opened the door for new approaches to health care management. As these technologies become more commonplace in our healthcare system, providers will seek third-party payer (private and public) coverage for these new diagnostic and disease-management tools. The process of educating payers and requesting coverage and reimbursement for new equipment will be challenging as this represents a shift in patient management and interaction.
There is an emergence of medical policy addressing use of mobile and wireless diagnostic equipment. Quorum worked with a medical device manufacturer interested in developing a new mobile and wireless diagnostic technology to evaluate market opportunities and trends in payer coverage for wireless diagnostic devices.
Our Approach
Diagnostic equipment to monitor cardiac rhythm is varied and diverse. Physicians have a range of devices to choose from, including capital equipment used in the hospital in-patient setting, all the way to implanted devices that record and transmit cardiac rhythms while the patient performs daily activities. In addition to this diversity of equipment, advances in technology have required shifts in payers’ approach to coverage and reimbursement for new cardiac monitoring devices.
Prior to the development of their own technology, Quorum’s client was interested in performing research to answer the following questions: (1) Do physicians use cardiac monitoring devices in a step-wise fashion when seeking a diagnosis? (2) Do physicians have a preferred diagnostic modality when monitoring cardiac rhythm? (3) What does the current reimbursement landscape look like for emerging cardiac monitoring technologies?
Our Solution
To evaluate trends in cardiac monitoring utilization, and understand the reimbursement landscape, Quorum’s Healthcare Data and Applications Division performed a comprehensive and creative analysis of historical claims data using the Medicare Physician/Supplier Part B 5% Standard Analytical File (SAF). This analysis provided the client with the following reports:
* Annual trends in diagnostic and therapeutic decisions by disease
* Actual utilization rates for each type of cardiac monitoring technology
* Submitted charges and Medicare reimbursement for each cardiac monitoring event
Results Delivered
Our client used these data to initiate dialogue with physician focus groups about diagnostic needs and gaps in cardiac monitoring technology offerings. These data have also allowed the client to understand third-party payer hurdles and develop strategy to overcome reimbursement barriers.
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