The health care economics of new drugs and devices has seemed perpetually riven with reimbursement's holy trinity -- coverage, coding, and payment. A whole industry of specialists and in-house experts has grown up around this mantra -- endlessly mouthed over the last 25 years as reimbursement controls on new products have gotten tighter and tougher.
But one senses that coveragecodingpayment, while to this day not unimportant, is increasingly no more than the elephant's toenail. There are bigger pieces to this elephant, visible to anyone willing to look around and acknowledge the animal as being in the room. The Way We Reimburse Today -- e.g., radiology benefits management, jumbo Medicare "demonstration" programs -- is flavored by decision making that is top-down; holistic; grounded deeply in clinical quality (cost-effectiveness being so 1990s).
Take Medicare's new Chronic Care Improvement Program. It will skirt across Parts A, B, and D to set out disease-management protocols for chronic conditions. Take the emergence of giant data pools from which all manner of regulatory and reimbursement agencies will graze, chewing on the data to come up with performance and effectiveness profiles on new products. This new world is about heft and breadth; about cutting across old categories to get done things that somebody has already decided should be done.
Because the real action and thinking start from on high, the wave of new policies is not percolating up from -- but instead trickling down through -- the channels of coveragecodingpayment. And so our familiar trilogy still finds pertinence . . . as plumbing. It gets the water to where it's destined to go.
To all this, future posts will be dedicated. But for now:
"Come gather 'round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You'll be drenched to the bone.
If your time to you
Is worth savin'
Then you better start swimmin'
Or you'll sink like a stone
For the times they are a-changin'."
("The Times They Are A-Changin," Bob Dylan, Copyright © 1963; renewed 1991 Special Rider Music.)
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