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Integration of new technology into clinical practice after FDA approval

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Abstract

Development of new medical technology is a crucial part of the advancement of medicine and our ability to better treat patients and their diseases. This process of development is long and arduous and requires a significant investment of human, financial and material capital. However, technology development can be rewarded richly by its impact on patient outcomes and successful sale of the product. One of the major regulatory hurdles to technology development is the Food and Drug Administration (FDA) approval process, which is necessary before a technology can be marketed and sold in the USA. Many businesses, medical providers and consumers believe that the FDA approval process is the only hurdle prior to use of the technology in day-to-day care. In order for the technology to be adopted into clinical use, reimbursement for both the device as well as the associated work performed by physicians and medical staff must be in place. Work and coverage decisions require Current Procedural Terminology (CPT) code development and Relative Value Scale Update Committee (RUC) valuation determination. Understanding these processes is crucial to the timely availability of new technology to patients and providers. Continued and better partnerships between physicians, industry, regulatory bodies and payers will facilitate bringing technology to market sooner and ensure appropriate utilization.

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References

  1. Center for Medicare and Medicaid Services. New medical services and new technologies. (https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/newtech.html). Updated October 16, 2015. Accessed 28 Oct 2015.

  2. Center for Medicare and Medicaid Services. Fiscal Year (FY) 2015 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2014-Transmittals-Items/R3138CP.html. Accessed 20 Dec 2015.

  3. American Medical Association. CPT® Process—how a code becomes a code. http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-process-faq/code-becomes-cpt.page. Accessed 15 Sept 2015.

  4. American Medical Association. The RVS update process booklet. Chicago: American Medical Association; 2014.

    Google Scholar 

  5. Laugesen MJ. The resource-based relative value scale and physician reimbursement policy. Chest. 2014;146(5):1413–9.

    Article  PubMed  Google Scholar 

  6. American Medical Association. The RVS Update Committee. http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/medicare/the-resource-based-relative-value-scale/the-rvs-update-committee.page?. Accessed 18 Sept 2015.

  7. Centers for Medicare and Medicaid Services. Medicare Program; revised process for making national coverage determinations. Fed Regist. 2013;28(52):48164–9.

    Google Scholar 

  8. Levinson DR, et al. Local coverage determinations create inconsistency in Medicare coverage (OEI-01-11-00500). Department of Health and Human Services, Office of Inspector General; 2014.

  9. Centers for Medicare and Medicaid Services. National coverage determinations with data collection as a condition of coverage: coverage with evidence development. https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/ced.pdf. Published July 12, 2006. Accessed 28 Oct 2015.

  10. Medicare Program Integrity Manual, Pub. No. 100–08, Chapter 13. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/pim83c13.pdf. Revised August 14, 2015. Accessed 3 Nov 2015.

  11. Trosman JR, Van Bebber SL, Phillips KA. Health technology assessment and private payers’ coverage of personalized medicine. Am J Manag Care. 2011;17(Suppl 5 Developing):SP53–60.

    PubMed  Google Scholar 

  12. Sullivan SD, Watkins J, Sweet B, et al. Health technology assessment in health-care decisions in the United States. Value Health. 2009;12 suppl 2:S39–44.

    Article  PubMed  Google Scholar 

  13. BlueCross BlueShield Association: technology evaluation center. http://www.bcbs.com/cce/.

  14. Hayes. http://www.hayesinc.com.

  15. BlueCross BlueShield Technology Evaluation Center website.

  16. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med. 1996;335(26):1933–40.

    Article  CAS  PubMed  Google Scholar 

  17. Buxton AE, Lee KL, DiCarlo L, Gold MR, Greer GS, Prystowsky EN, et al. Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med. 2000;342(26):1937–45.

    Article  CAS  PubMed  Google Scholar 

  18. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337(22):1576–83.

    Article  Google Scholar 

  19. Gregoratos G, Abrams J, Epstein AE, Freedman RA, Hayes DL, Hlatky MA, et al. ACC/AHA/NASPE 2002 guideline update for implantation of cardiac pacemakers and antiarrhythmia devices: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines). Circulation. 2002;106(16):2145–61.

    Article  PubMed  Google Scholar 

  20. Centers for Medicare and Medicaid Services. National coverage determination (NCD) for implantable automatic defibrillators. Medicare National Coverage Determinations (NCD) Manual; section 20.4, version 3. 2005.

  21. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83.

    Article  PubMed  Google Scholar 

  22. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 2005;352(3):225–37.

    Article  CAS  PubMed  Google Scholar 

  23. Zipes DP et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation. 2006;114:e385–484.

    Article  PubMed  Google Scholar 

  24. Epstein AE et al. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm. 2008;5(6):e1–e62.

    Article  PubMed  Google Scholar 

  25. Tracy CM et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm. 2012;9(10):1737–53.

    Article  PubMed  Google Scholar 

  26. Russo AM et al. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy. Heart Rhythm. 2013;10(4):e11–58.

    Article  PubMed  Google Scholar 

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Correspondence to Steven C. Hao.

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Govil, A., Hao, S.C. Integration of new technology into clinical practice after FDA approval. J Interv Card Electrophysiol 47, 19–27 (2016). https://doi.org/10.1007/s10840-016-0171-0

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