For reimbursement services support, email us at info@girsinc.com or call us at 901-834-9119.
What is HTA?
Health technology assessment (HTA) is an official research process intended to evaluate the current evidence for a medical treatment or health delivery advance technology. The investigation process includes a multi-faceted assessment of the clinical, economic, ethical, legal, and general perceptions that may be influenced by a new technology, procedure, drug, or process. The triggers for an HTA include the significant expansion of the population eligible for receipt of a new technology or when new evidence is available that could possibly alter the decisions of the original assessment called a re-review. GIRS tracks the outcomes of HTAs as they impact the coverage policies of government programs like Medicaid. We also assist our clients to submit evidence to HTA organizations to impact payer coverage policies positively. See our last Blog post on the State of Washington Health Care Authority (HCA) Three Recent Technology Assessments on July 6.
What is the Purpose of an HTA?
The purpose of an HTA is to review the available data on the costs and benefits of new technology so that it influences the policies of local and state government programs like Medicaid to enable access to the new technology by specific patient populations. It is important for #medtech to track HTAs as they impact coverage of drugs, medical devices, diagnostics, and biologics.
Technologies for Review, 2020
The Director of Washington HCA selected technologies for review after they were released for a comment period from July 15th to July 28th, 2020 and those comments were considered. The review is conducted by the Health Technology Clinical Committee in conference with other agencies and the Committee itself (70.14 RCW).
Non-invasive testing for coronary artery disease: The first topic for assessment is Non-invasive testing for coronary artery disease for which the costs are high, the efficacy is medium, and safety is ranked as medium. Coronary artery disease (CAD) is the obstruction or blockage of the coronary arteries. After a period, it can cause decrease blood flow traveling to the heart muscle. Effective and initial diagnosis of CAD can decrease the risk of heart attack or the expansion of more brutal heart disease.
There are many options to choose from when deciding on testing for CAD.
The assessment of this topic will include re-reviews of prior HTCC topics (cardiac nuclear imaging and computed tomographic angiography) and may include other anatomic and/or functional imaging tests.
Sacroiliac joint fusion: this topic was reviewed in 2019, is awaiting additional evaluation of the evidence submitted by stakeholders.
Chronic migraine and tension type headaches: this topic was reviewed in 2017 but was not chosen for re-review at this time because review of the new information submitted led to the conclusion that there was insufficient evidence to alter the previous decision. Below is a list of topics considered but not proposed for this year:
New technology topics considered; not proposed
- Allergy Testing
- Automated computed tomography (CT) perfusion imaging
- Denervation of the sacroiliac joint
- Fractional excretion of nitric oxide for asthma
- Hypoglossal nerve stimulation for sleep apnea
- Infra-low frequency neurofeedback
- Molecular profiling of tumors
- Multiplex respiratory viral panel testing
- Portable magnetic resonance imaging (MRI) (Hyperfine)
- Tissue-based regenerative therapy
Re‐review of technologies
Every eighteen months, technologies are considered for reevaluation due to new evidence that may alter the decision previously made. Below is a list of technologies that are beyond the 18 months review, since the concluding decisions were made previously:
The following will be re-reviewed:
- Cardiac nuclear imaging
- Computed tomographic angiography (CTA)
The following will not be reviewed:
- Artificial disc replacement
- Chronic migraine and chronic tension‐type headache
- Coronary calcium scoring
- Facet neurotomy
- Peripheral nerve ablation for limb pain
- Peripheral nerve ablation for limb pain
Sacroiliac joint fusion: the literature submitted by stakeholders is being reviewed for this topic.
Below are a few of the topics that have not been supported by sufficient evidence for a re-review.
- Arthroscopic knee surgery
- Autologous blood/ platelet‐rich plasma injections
- Bone growth stimulators
- Cervical spinal fusion for degenerative disc disease
- Electrical Neural Stimulations (ENS)
- Glucose monitoring
- Hip resurfacing
- Knee joint replacement or knee arthroplasty
- (Total knee arthroplasty)
- Lumbar fusion for degenerative disc disease
- Negative pressure wound therapy
- Osteochondral allograft / autograft transplantation knee
- Robotic assisted surgery
Why Partner with GIRS?
The GIRS Payer Advocacy Compass PAC® team tracks and educates stakeholders including HTA organizations to ensure coverage and reimbursement of our client’s medical technologies. Our work has enabled our clients and their accounts to:
- analyze the impact of payer policy changes for our clients’ Products;
- submit evidence to HTA organizations for re-re-reviews;
- work with state Medicaid agencies to reference the HTA decisions;
- submit and follow up on redeterminations;
- submit evidence of the medical necessity by communicating payer needs with the providers;
- comment on policy changes on time;
- correct mistakes in payer policies;
- clarify policy language for accounts;
- educate the sales force and accounts in new payer policy language;
- overturn negative coverage decisions;
- lay the foundation of customized payer advocacy strategies based on policy changes;
If you need to submit new evidence for review, we have the expertise to review your evidence and prepare it for submission to the various HCA organizations. For more information, email us at info@girsinc.com or call us at 901-834-9119.
Disclaimer: The information in this blog is based on payer information which is dynamic. It is accurate at the time of posting but should not be construed to be reimbursement or legal advice. CPT® is the trademark of the American Medical Association (AMA).
Sources:
https://hca.wa.gov/assets/program/5-2020-final-topic-selection-compiled-20200811.pdf
About GIRS
For more than 17 years, GIRS has been assisting medical technology manufacturers with their market uptake and reimbursement strategies so that patients can have access to the care that they need. To implement successful market access strategies, the GIRS Value Discovery Landscape Assessments® team and the Payer Advocacy Compass® team work together to develop and implement foundation reimbursement landscape and payer advocacy strategies to obtain positive coverage, appropriate payment, and innovative payer contracting arrangements to improve market uptake. For more information, email us at info@girsinc.com or call us at 901-834-9119.