1 00:00:00,080 --> 00:00:02,560 Hello, everyone. This is Erica Spicer Mason with 2 00:00:02,560 --> 00:00:04,799 Becker's Healthcare. Thank you so much for tuning 3 00:00:04,799 --> 00:00:06,980 into the Becker's Healthcare podcast series. 4 00:00:07,519 --> 00:00:09,439 I'm pleased to be joined today by April 5 00:00:09,439 --> 00:00:12,740 Spillane, vice president of health economics at Barricade. 6 00:00:13,574 --> 00:00:15,255 April's here to talk to us today about 7 00:00:15,255 --> 00:00:15,914 some reimbursement 8 00:00:16,214 --> 00:00:17,515 challenges and opportunities 9 00:00:17,815 --> 00:00:19,515 in the spinal procedure space. 10 00:00:20,214 --> 00:00:22,214 April, welcome to the podcast, and thank you 11 00:00:22,214 --> 00:00:23,435 again for joining us. 12 00:00:23,814 --> 00:00:25,835 Thank you. Good morning. Nice to be here. 13 00:00:26,140 --> 00:00:27,899 We're thrilled to have you with us. And 14 00:00:27,899 --> 00:00:29,599 before we get into our discussion, 15 00:00:30,059 --> 00:00:32,219 wondering if you can tell our listeners a 16 00:00:32,219 --> 00:00:34,140 little bit about Barricade. I know it's a 17 00:00:34,140 --> 00:00:36,059 new technology that sounds like it's set up 18 00:00:36,059 --> 00:00:37,840 to help a lot of people. So, 19 00:00:38,219 --> 00:00:40,064 whatever you feel is important to share with 20 00:00:40,064 --> 00:00:41,684 our listeners, I think, would be really helpful. 21 00:00:42,704 --> 00:00:44,804 Yes. I am the vice president 22 00:00:45,184 --> 00:00:48,004 of health economics at Intrinsic Therapeutics. 23 00:00:48,784 --> 00:00:49,284 Intrinsic 24 00:00:49,664 --> 00:00:50,884 Therapeutics manufactures 25 00:00:51,424 --> 00:00:52,884 the Barricade device. 26 00:00:53,539 --> 00:00:56,500 It's a bone anchored annular closure device. And, 27 00:00:56,500 --> 00:00:57,000 essentially, 28 00:00:57,859 --> 00:01:00,979 what it's used for is we close the 29 00:01:00,979 --> 00:01:01,479 hole 30 00:01:02,179 --> 00:01:03,159 after a discectomy. 31 00:01:03,780 --> 00:01:04,840 There is a subset 32 00:01:05,140 --> 00:01:07,875 of patients who have a large hole, and 33 00:01:07,875 --> 00:01:10,534 they're at significantly higher risk of re herniating. 34 00:01:11,394 --> 00:01:14,295 So the surgeon is able to 35 00:01:14,594 --> 00:01:15,094 measure, 36 00:01:15,715 --> 00:01:17,875 verify if they're high risk or low risk. 37 00:01:17,875 --> 00:01:20,435 And if they're high risk, we anchor into 38 00:01:20,435 --> 00:01:23,530 the bone, plug that hole and prevent the 39 00:01:23,530 --> 00:01:25,709 risk of a second operation, 40 00:01:26,329 --> 00:01:27,310 which is fantastic 41 00:01:27,609 --> 00:01:31,450 because it really eliminates this downstream effect of 42 00:01:31,450 --> 00:01:32,590 multiple surgeries, 43 00:01:33,289 --> 00:01:36,170 whether that be multiple discectomies and then fusion 44 00:01:36,170 --> 00:01:38,509 or just going from discectomy to fusion. 45 00:01:39,954 --> 00:01:42,114 Yeah. April, thanks so much for sharing more 46 00:01:42,114 --> 00:01:44,274 about your background. It sounds like you're bringing 47 00:01:44,274 --> 00:01:45,494 really great experience. 48 00:01:45,954 --> 00:01:47,634 I wanna also touch on something you said, 49 00:01:47,634 --> 00:01:49,795 and that's kind of this idea that you 50 00:01:49,795 --> 00:01:50,935 essentially oversee 51 00:01:51,420 --> 00:01:54,239 all all things reimbursement for an emerging technology. 52 00:01:54,379 --> 00:01:55,980 So would love to know a little bit 53 00:01:55,980 --> 00:01:57,980 more about what draws you to this, and 54 00:01:57,980 --> 00:02:00,060 also what problem are you trying to solve 55 00:02:00,060 --> 00:02:00,959 in this work? 56 00:02:01,659 --> 00:02:02,959 Yeah. I think specifically 57 00:02:03,659 --> 00:02:04,319 at Intrinsic, 58 00:02:05,224 --> 00:02:07,304 you know, it's really the patients, you know, 59 00:02:07,304 --> 00:02:08,844 the patients and the providers 60 00:02:09,224 --> 00:02:11,544 that probably make you get out of bed 61 00:02:11,544 --> 00:02:14,125 and and do this every single day. 62 00:02:14,664 --> 00:02:17,724 You know, in my job, we cover everything 63 00:02:18,025 --> 00:02:21,469 from coding coverage payment, but also the authorization 64 00:02:21,769 --> 00:02:24,109 process, and we work with physician practices 65 00:02:24,409 --> 00:02:25,069 and patients. 66 00:02:26,169 --> 00:02:27,389 We have a rare 67 00:02:28,250 --> 00:02:28,750 scenario 68 00:02:29,209 --> 00:02:29,709 where 69 00:02:30,169 --> 00:02:33,069 we hear from patients and providers about 70 00:02:33,735 --> 00:02:36,235 when patients actually don't get the right treatment 71 00:02:36,615 --> 00:02:39,014 and what that journey is like to and 72 00:02:39,014 --> 00:02:40,775 how long it takes to be able to 73 00:02:40,775 --> 00:02:41,995 get the correct treatment. 74 00:02:42,455 --> 00:02:44,555 So, you know, for a barricade patient, 75 00:02:45,254 --> 00:02:46,955 these patients are discectomies. 76 00:02:47,254 --> 00:02:49,819 They're done all day every day, but there's 77 00:02:49,819 --> 00:02:52,539 a subset of discectomy patients that are at 78 00:02:52,539 --> 00:02:53,680 high risk of reherniation, 79 00:02:54,539 --> 00:02:56,000 and it's really devastating 80 00:02:56,539 --> 00:02:57,519 when they reherniate. 81 00:02:58,139 --> 00:02:59,840 I mean, just some of the stories 82 00:03:00,139 --> 00:03:02,159 done where we've met with payers, 83 00:03:02,514 --> 00:03:04,594 and we've had patients that didn't get access 84 00:03:04,594 --> 00:03:05,414 to the treatment. 85 00:03:05,715 --> 00:03:06,534 They reherniate. 86 00:03:06,914 --> 00:03:08,935 They end up having a huge fusion. 87 00:03:09,555 --> 00:03:12,375 Fast forward, 6 more months down the road, 88 00:03:12,594 --> 00:03:14,854 you know, an an additional surgery. 89 00:03:15,540 --> 00:03:17,219 And, you know, some of these patients are 90 00:03:17,219 --> 00:03:20,099 just middle aged moms like myself, and they're 91 00:03:20,099 --> 00:03:22,520 out of work for 18 months. And so 92 00:03:22,740 --> 00:03:25,060 when you hear these stories over and over 93 00:03:25,060 --> 00:03:26,760 and over again, it really 94 00:03:27,314 --> 00:03:27,814 empowers 95 00:03:28,194 --> 00:03:29,014 you to 96 00:03:29,635 --> 00:03:32,034 get a solution and fix. And I think 97 00:03:32,034 --> 00:03:35,175 every patient has the right to 98 00:03:35,715 --> 00:03:37,635 the best treatment, and they have the right 99 00:03:37,635 --> 00:03:38,534 to be educated 100 00:03:38,915 --> 00:03:41,750 on the various treatment options there are for 101 00:03:41,750 --> 00:03:42,810 their disease state. 102 00:03:43,989 --> 00:03:46,629 Yeah. April, you're highlighting something so important, which 103 00:03:46,629 --> 00:03:49,610 is all of these consequences of potentially delayed 104 00:03:49,669 --> 00:03:52,229 surgeries or treatments and how that can affect 105 00:03:52,229 --> 00:03:54,224 patients in the long run. I know it 106 00:03:54,224 --> 00:03:56,724 has an impact on businesses as well, so 107 00:03:57,185 --> 00:03:59,685 appreciate how you you outlined those issues. 108 00:04:00,305 --> 00:04:02,544 And I know that another trend we're seeing 109 00:04:02,544 --> 00:04:05,664 is certainly an increase in spine procedures in 110 00:04:05,664 --> 00:04:06,164 general. 111 00:04:07,099 --> 00:04:08,460 In fact, I know that over the last 112 00:04:08,460 --> 00:04:11,020 decade, the total number of outpatient spine procedures 113 00:04:11,020 --> 00:04:12,159 rose by a staggering 114 00:04:13,099 --> 00:04:13,599 193%. 115 00:04:14,699 --> 00:04:16,540 So can you share with our listeners what 116 00:04:16,540 --> 00:04:18,860 you're seeing as the driving factors behind that 117 00:04:18,860 --> 00:04:20,540 shift and the impact that you think it 118 00:04:20,540 --> 00:04:22,160 will have in the year to come? 119 00:04:22,904 --> 00:04:25,384 Yeah. The way I visualize it is I 120 00:04:25,384 --> 00:04:27,164 think there's pre and post COVID. 121 00:04:27,464 --> 00:04:29,144 So like I said, I've spent probably the 122 00:04:29,144 --> 00:04:31,485 last 15 years in outpatient, 123 00:04:32,104 --> 00:04:34,365 and specifically the last 10 in spine. 124 00:04:34,824 --> 00:04:37,644 You know, I think pre COVID, you had 125 00:04:38,039 --> 00:04:40,139 a lot of high recuity cases 126 00:04:40,439 --> 00:04:41,339 in the musculoskeletal 127 00:04:41,720 --> 00:04:44,139 and orthopedic space that were transitioning 128 00:04:44,599 --> 00:04:45,740 safely and effectively 129 00:04:46,120 --> 00:04:46,620 into 130 00:04:47,159 --> 00:04:50,220 the outpatient setting. You started to 131 00:04:50,599 --> 00:04:51,500 see patients 132 00:04:51,865 --> 00:04:52,604 a lot more 133 00:04:52,904 --> 00:04:55,084 engaged in out of pocket expenses. 134 00:04:55,704 --> 00:04:57,084 And then you also saw 135 00:04:57,544 --> 00:05:00,444 Medicare's ASC eligible list start expanding. 136 00:05:00,745 --> 00:05:02,344 So I think that that was kind of 137 00:05:02,344 --> 00:05:05,404 the catalyst, and we were already seeing spine 138 00:05:05,910 --> 00:05:06,970 start to transition 139 00:05:07,350 --> 00:05:07,850 outpatient 140 00:05:08,550 --> 00:05:09,370 pre COVID. 141 00:05:09,830 --> 00:05:11,990 Then COVID hit and it really just kind 142 00:05:11,990 --> 00:05:14,710 of expedited the shift. In my opinion, I 143 00:05:14,710 --> 00:05:15,850 was working for 144 00:05:16,310 --> 00:05:18,790 a spine manufacturer at the time. I remember 145 00:05:18,790 --> 00:05:20,805 it vividly, you know, the world really shut 146 00:05:20,805 --> 00:05:22,745 shut down, and we didn't have 147 00:05:23,204 --> 00:05:26,104 access to ORs in the hospital setting. 148 00:05:26,564 --> 00:05:29,685 And so whether you were a player in 149 00:05:29,685 --> 00:05:31,845 the ASC space or not, a lot of 150 00:05:31,845 --> 00:05:35,204 patients and providers shifted their cases there. And 151 00:05:35,204 --> 00:05:36,664 I think once it was 152 00:05:37,019 --> 00:05:40,220 done safely and once there was reimbursement in 153 00:05:40,220 --> 00:05:40,720 place 154 00:05:41,420 --> 00:05:43,839 and the operational flow kind of 155 00:05:44,220 --> 00:05:46,399 stuck over a period of time, 156 00:05:47,339 --> 00:05:49,964 it really just expedited the shift. So I 157 00:05:49,964 --> 00:05:53,724 think, you know, payers, providers, facilities, everyone's kind 158 00:05:53,724 --> 00:05:55,104 of rolled up their sleeves 159 00:05:55,404 --> 00:05:56,544 and learned to, 160 00:05:57,404 --> 00:06:00,764 manage spine procedures in the outpatient setting. And 161 00:06:00,764 --> 00:06:02,704 the key factors you need is you need 162 00:06:02,764 --> 00:06:04,290 it to be clinically safe, 163 00:06:04,770 --> 00:06:06,770 and you need it to be reimbursed and 164 00:06:06,770 --> 00:06:07,509 cost effective. 165 00:06:08,370 --> 00:06:10,129 Yeah. Thanks so much, April. And I I 166 00:06:10,129 --> 00:06:11,889 think you've already started to touch on something 167 00:06:11,889 --> 00:06:13,250 that I was curious to know a bit 168 00:06:13,250 --> 00:06:15,670 more about. So you're talking about the shift 169 00:06:15,970 --> 00:06:17,175 of discectomy 170 00:06:17,555 --> 00:06:20,134 surgeries from inpatient to outpatient, and, 171 00:06:21,074 --> 00:06:22,835 you know, you're acknowledging that ASCs need to 172 00:06:22,835 --> 00:06:25,235 be equipped to handle those cases, and there 173 00:06:25,235 --> 00:06:27,574 may be some benefits like faster room turnover. 174 00:06:27,875 --> 00:06:29,475 Just curious if you can elaborate a bit 175 00:06:29,475 --> 00:06:30,930 more on your view of that shift in 176 00:06:30,930 --> 00:06:32,210 general. Do you think this is a good 177 00:06:32,210 --> 00:06:32,710 thing? 178 00:06:33,490 --> 00:06:35,250 Yeah. I think it's a good thing. I 179 00:06:35,250 --> 00:06:35,750 think, 180 00:06:36,529 --> 00:06:38,069 you know, years ago, 181 00:06:38,610 --> 00:06:41,509 maybe we didn't have the appropriate staff, equipment, 182 00:06:41,889 --> 00:06:42,389 infrastructure 183 00:06:42,850 --> 00:06:43,590 to handle, 184 00:06:44,129 --> 00:06:45,110 spine procedures, 185 00:06:46,404 --> 00:06:47,305 but that's 186 00:06:47,685 --> 00:06:49,925 that doesn't seem to be the norm now. 187 00:06:49,925 --> 00:06:52,345 I think a lot of outpatient centers, 188 00:06:52,805 --> 00:06:54,884 are equipped to handle spine, and they've got 189 00:06:54,884 --> 00:06:55,704 the appropriate 190 00:06:56,164 --> 00:06:58,264 staff and equipment in place. 191 00:06:58,644 --> 00:07:00,345 And then, you know, 192 00:07:00,870 --> 00:07:01,770 making sure 193 00:07:02,550 --> 00:07:03,050 reimbursement 194 00:07:03,670 --> 00:07:05,850 is a viable option as well. 195 00:07:06,150 --> 00:07:08,389 So I think you've seen a lot of 196 00:07:08,389 --> 00:07:12,470 ambulatory surgery centers start to either proactively on 197 00:07:12,470 --> 00:07:14,889 their own or through a consulting firm 198 00:07:15,274 --> 00:07:17,754 work on their managed care contracts with payers 199 00:07:17,754 --> 00:07:19,375 so that they can afford 200 00:07:19,675 --> 00:07:20,975 to do the spine procedures. 201 00:07:21,595 --> 00:07:22,735 That combination 202 00:07:23,115 --> 00:07:25,774 of factors makes it a very viable procedure. 203 00:07:26,235 --> 00:07:28,014 I think the out of pocket expenses 204 00:07:28,395 --> 00:07:30,689 are in the best interest of the patient. 205 00:07:30,689 --> 00:07:31,750 It's a little cheaper. 206 00:07:32,290 --> 00:07:35,569 And I I just think it's, overall a 207 00:07:35,569 --> 00:07:36,389 good thing. 208 00:07:36,770 --> 00:07:38,470 And I think it's just kind of organically 209 00:07:38,770 --> 00:07:41,350 happening. We've really, really seen discectomy, 210 00:07:42,745 --> 00:07:45,564 almost completely shift outpatient at this point. 211 00:07:46,185 --> 00:07:46,685 Mhmm. 212 00:07:46,985 --> 00:07:47,725 Yeah. Fascinating. 213 00:07:48,425 --> 00:07:50,204 And you you touched on how reimbursement 214 00:07:50,504 --> 00:07:53,545 challenges are are top of mind for ASCs 215 00:07:53,545 --> 00:07:55,384 and spine leaders as the as the shift 216 00:07:55,384 --> 00:07:56,845 is progressing. So 217 00:07:57,439 --> 00:07:59,120 aside from I I think you had mentioned 218 00:07:59,120 --> 00:08:01,759 that some ASCs are proactively or even on 219 00:08:01,759 --> 00:08:03,839 their own working on managed care contracts so 220 00:08:03,839 --> 00:08:05,779 they can, of course, afford the procedures. 221 00:08:06,160 --> 00:08:08,020 Are there any other trends or opportunities 222 00:08:08,560 --> 00:08:10,819 regarding reimbursement that you're watching here? 223 00:08:11,694 --> 00:08:14,335 Yeah. I think the facilities can negotiate and 224 00:08:14,335 --> 00:08:15,074 work proactively 225 00:08:15,455 --> 00:08:18,355 on the payment side and the contracting side. 226 00:08:18,654 --> 00:08:20,895 You know, the part that I'm I'm really 227 00:08:20,895 --> 00:08:22,915 monitoring and that I'd like to see 228 00:08:23,455 --> 00:08:26,275 get a little better is the policy side. 229 00:08:26,769 --> 00:08:28,850 You know, I think I'm curious to watch 230 00:08:28,850 --> 00:08:31,569 kind of the checks and balances between the 231 00:08:31,569 --> 00:08:33,269 commercial payers and 232 00:08:34,049 --> 00:08:34,870 kind of the 233 00:08:35,250 --> 00:08:36,870 government over overseeing, 234 00:08:37,570 --> 00:08:39,350 things in the commercial space. 235 00:08:39,845 --> 00:08:42,165 You know, it's been an interesting few years 236 00:08:42,165 --> 00:08:43,304 you've really seen, 237 00:08:44,004 --> 00:08:46,804 prior authorization kinda go away. I think people 238 00:08:46,804 --> 00:08:47,304 have 239 00:08:47,684 --> 00:08:49,684 pros and cons to that depending on which 240 00:08:49,684 --> 00:08:51,065 side of the aisle you're on. 241 00:08:51,684 --> 00:08:53,460 And then we've really seen kind of 242 00:08:53,860 --> 00:08:54,360 medical 243 00:08:54,899 --> 00:08:55,399 policy 244 00:08:56,179 --> 00:08:58,040 change to where, 245 00:08:58,500 --> 00:09:01,700 you know, some commercial payers are, you know, 246 00:09:01,700 --> 00:09:04,679 writing policy on their own, others are outsourcing 247 00:09:04,980 --> 00:09:06,840 it. And so that's become 248 00:09:07,460 --> 00:09:09,075 a little vague as well. 249 00:09:09,875 --> 00:09:12,514 And I think just the combination of those 250 00:09:12,514 --> 00:09:14,294 two things, it's become, 251 00:09:14,835 --> 00:09:17,634 I would say, more risk for patients and 252 00:09:17,634 --> 00:09:19,575 providers or it feels riskier 253 00:09:20,274 --> 00:09:21,840 to move forward with new 254 00:09:36,480 --> 00:09:38,144 they end up having 255 00:09:38,524 --> 00:09:40,284 to either get paid or appeal on the 256 00:09:40,284 --> 00:09:42,845 back end. So I've I've I think that 257 00:09:42,845 --> 00:09:46,125 that conundrum is gonna be interesting to watch 258 00:09:46,125 --> 00:09:48,605 over the next couple of years in how 259 00:09:48,605 --> 00:09:50,464 we're gonna handle it in health care. 260 00:09:50,924 --> 00:09:53,279 Mhmm. Yeah. Appreciate you sharing that with our 261 00:09:53,279 --> 00:09:54,179 listeners, April. 262 00:09:54,720 --> 00:09:55,919 And kind of in the same vein, I 263 00:09:55,919 --> 00:09:57,860 know oftentimes when we talk about reimbursement, 264 00:09:58,799 --> 00:10:01,759 codes come into the conversation as well. So 265 00:10:01,759 --> 00:10:02,740 are there any 266 00:10:03,199 --> 00:10:05,539 new medical codes that you think are important 267 00:10:05,919 --> 00:10:06,419 regarding 268 00:10:06,834 --> 00:10:08,914 discectomy is that you think our listeners should 269 00:10:08,914 --> 00:10:11,554 know about, especially as they might impact financial 270 00:10:11,554 --> 00:10:13,894 viability and and patient care more broadly? 271 00:10:14,754 --> 00:10:16,674 You know, I think there's been kind of 272 00:10:16,674 --> 00:10:18,615 coding in place for standard discectomy. 273 00:10:19,830 --> 00:10:22,330 I can speak to the Barricade procedure. 274 00:10:22,870 --> 00:10:24,330 We were fortunate 275 00:10:24,870 --> 00:10:28,330 to have a procedure code assigned by Medicare 276 00:10:28,470 --> 00:10:31,029 so that facilities have a code to bill 277 00:10:31,029 --> 00:10:31,930 for the procedure. 278 00:10:32,745 --> 00:10:35,404 We also have ICD 10 codes to 279 00:10:35,945 --> 00:10:39,465 to really report annular defect size, which is 280 00:10:39,465 --> 00:10:40,924 is really what's needed, 281 00:10:41,465 --> 00:10:44,684 to and required to meet medical necessity. 282 00:10:45,410 --> 00:10:46,950 And then the societies, 283 00:10:47,649 --> 00:10:49,350 have been working to, 284 00:10:49,809 --> 00:10:52,290 get a a new CPT code in place, 285 00:10:52,290 --> 00:10:54,370 and we anticipate that that's gonna go into 286 00:10:54,370 --> 00:10:55,430 effect in 2026. 287 00:10:55,889 --> 00:10:57,430 So that's kind of been a major 288 00:10:57,975 --> 00:10:58,475 milestone 289 00:10:58,774 --> 00:10:59,575 as well, 290 00:10:59,894 --> 00:11:02,154 for our procedure, which again, complements, 291 00:11:03,014 --> 00:11:06,134 your traditional discectomy. This is just for patients 292 00:11:06,134 --> 00:11:08,054 who are at higher risk with a large 293 00:11:08,054 --> 00:11:08,554 defect. 294 00:11:09,910 --> 00:11:10,570 Yeah. Absolutely. 295 00:11:10,950 --> 00:11:12,629 I I think it's it's great to learn 296 00:11:12,629 --> 00:11:14,470 more about kind of some of these milestones 297 00:11:14,470 --> 00:11:15,370 that you're seeing, 298 00:11:15,990 --> 00:11:18,149 especially just to help better set the stage 299 00:11:18,149 --> 00:11:20,870 and better equip ASCs for handling this, you 300 00:11:20,870 --> 00:11:23,290 know, this influx of spinal procedures. 301 00:11:24,470 --> 00:11:25,485 This has been so helpful. 302 00:11:36,840 --> 00:11:40,170 I mentioned that I mentioned that CMS created 303 00:11:40,389 --> 00:11:42,470 a procedure code for this the work of 304 00:11:42,470 --> 00:11:44,490 the discectomy and implanting, 305 00:11:45,029 --> 00:11:47,050 a bone anchored angular closure device. 306 00:11:47,430 --> 00:11:49,830 So that's kind of opened the gates for 307 00:11:49,830 --> 00:11:52,835 both Medicare and the commercial payers to be 308 00:11:52,835 --> 00:11:55,575 able to have a code to reimburse facilities 309 00:11:55,795 --> 00:11:56,455 right now. 310 00:11:56,995 --> 00:11:59,154 And then we've got the ICD 10 codes 311 00:11:59,154 --> 00:12:02,195 to report medical necessity based on the defect 312 00:12:02,195 --> 00:12:02,695 size. 313 00:12:03,149 --> 00:12:05,389 Some of the other things that we've done 314 00:12:05,389 --> 00:12:05,889 internally, 315 00:12:07,230 --> 00:12:09,730 we have a patient journey program, 316 00:12:10,589 --> 00:12:11,490 which actually 317 00:12:12,429 --> 00:12:15,904 supports practices and patients through the authorization 318 00:12:16,284 --> 00:12:17,664 and appeals process. 319 00:12:18,605 --> 00:12:21,084 We do a lot of front end and 320 00:12:21,084 --> 00:12:23,264 back end education to facilities 321 00:12:24,205 --> 00:12:25,584 to make sure that 322 00:12:26,044 --> 00:12:27,024 they are educated 323 00:12:27,404 --> 00:12:29,909 on the coding and reimbursement, and we actually 324 00:12:29,909 --> 00:12:31,289 follow-up and offer 325 00:12:31,669 --> 00:12:32,330 the option, 326 00:12:32,789 --> 00:12:34,409 to verify that payment 327 00:12:35,029 --> 00:12:37,350 is in place or if an appeal is 328 00:12:37,350 --> 00:12:39,350 needed. We have that as well. And then 329 00:12:39,350 --> 00:12:40,089 we've implemented 330 00:12:40,549 --> 00:12:42,710 a risk sharing model as well for our 331 00:12:42,710 --> 00:12:43,210 facilities, 332 00:12:44,134 --> 00:12:47,335 which again, kinda coincides with those other 2 333 00:12:47,335 --> 00:12:47,835 programs. 334 00:12:48,375 --> 00:12:50,774 And I think what that's done is allow 335 00:12:50,774 --> 00:12:52,715 facilities and patients and providers, 336 00:12:53,735 --> 00:12:55,595 to move forward with the surgery, 337 00:12:56,379 --> 00:12:57,199 give the patient 338 00:12:57,500 --> 00:12:59,039 the appropriate treatment, 339 00:12:59,740 --> 00:13:02,879 and, it really just mitigates the the financial 340 00:13:02,940 --> 00:13:03,440 risk. 341 00:13:04,459 --> 00:13:06,139 So just I guess I'd like to hear 342 00:13:06,139 --> 00:13:07,820 more from you, April, to close out our 343 00:13:07,820 --> 00:13:08,320 conversation. 344 00:13:08,779 --> 00:13:11,764 Anything else in regards to Barricade and innovation 345 00:13:12,384 --> 00:13:14,705 in your work that you're excited about and 346 00:13:14,705 --> 00:13:16,325 that you think will really make a difference 347 00:13:16,384 --> 00:13:17,205 at ASCs, 348 00:13:17,825 --> 00:13:19,045 in the years to come? 349 00:13:19,665 --> 00:13:20,965 Yeah. I think in 2025 350 00:13:21,585 --> 00:13:23,850 is gonna be unique here. You know, we 351 00:13:23,850 --> 00:13:25,470 worked pretty diligently 352 00:13:26,330 --> 00:13:28,029 with the team at CMS 353 00:13:28,409 --> 00:13:28,909 about 354 00:13:29,690 --> 00:13:32,589 just a a reporting concern with c codes. 355 00:13:32,809 --> 00:13:35,370 They looked into this in the final rule. 356 00:13:35,370 --> 00:13:36,409 They did modify, 357 00:13:37,184 --> 00:13:39,424 and put a new policy in place. And 358 00:13:39,424 --> 00:13:39,924 so, 359 00:13:40,225 --> 00:13:42,945 you know, we're gonna see not just to 360 00:13:42,945 --> 00:13:46,544 BARRICADE, but overall that hospitals are required to 361 00:13:46,544 --> 00:13:47,044 report 362 00:13:47,345 --> 00:13:48,004 a device, 363 00:13:48,625 --> 00:13:50,085 when it's a device intensive 364 00:13:50,500 --> 00:13:51,000 procedure. 365 00:13:51,300 --> 00:13:54,259 How that pertains to BARRICADE is we had 366 00:13:54,259 --> 00:13:56,200 lost device intensive status 367 00:13:56,740 --> 00:13:59,779 because of inadvertent misreporting, and now we've regained 368 00:13:59,779 --> 00:14:02,740 it. And that, has really correlated to about 369 00:14:02,740 --> 00:14:03,320 a $3,000 370 00:14:03,940 --> 00:14:06,040 increase in the ASC setting. 371 00:14:06,464 --> 00:14:09,745 What that does is it opens the door 372 00:14:09,745 --> 00:14:10,404 for beneficiary 373 00:14:10,865 --> 00:14:11,365 access, 374 00:14:11,745 --> 00:14:13,444 in the Medicare patient population 375 00:14:14,225 --> 00:14:15,605 for the BERICADE procedure, 376 00:14:16,464 --> 00:14:20,004 which is fantastic. You know, patients and facilities 377 00:14:20,225 --> 00:14:22,230 who wanna do this procedure can do it. 378 00:14:22,230 --> 00:14:24,149 They can afford to do it. It's more 379 00:14:24,149 --> 00:14:24,889 cost effective. 380 00:14:25,750 --> 00:14:27,909 And, I think that that's a big game 381 00:14:27,909 --> 00:14:31,210 changer for surgery centers. They're already doing discectomies. 382 00:14:32,070 --> 00:14:34,549 They can now offer Barricade. They can afford 383 00:14:34,549 --> 00:14:35,450 to offer it, 384 00:14:35,985 --> 00:14:38,785 and the reimbursement increase is makes this a 385 00:14:38,785 --> 00:14:42,065 very viable opportunity for them. And then as 386 00:14:42,065 --> 00:14:42,865 we all know, 387 00:14:43,424 --> 00:14:46,485 many commercial payers kind of follow suit or 388 00:14:46,544 --> 00:14:49,024 have their own formulary for payment based off 389 00:14:49,024 --> 00:14:49,684 of Medicare. 390 00:14:50,090 --> 00:14:52,009 So I think it's a great time for 391 00:14:52,009 --> 00:14:54,669 surgery centers who are interested in this technology 392 00:14:55,370 --> 00:14:57,529 to take it. I also think, you know, 393 00:14:57,529 --> 00:15:01,049 BARRICADE certainly fills an unmet clinical need for 394 00:15:01,049 --> 00:15:02,509 large defect patients, 395 00:15:02,970 --> 00:15:04,269 and it's very marketable. 396 00:15:04,889 --> 00:15:08,325 Patients are smart. They research. They wanna know 397 00:15:08,625 --> 00:15:10,704 the pros, the cons, the risks of any 398 00:15:10,704 --> 00:15:13,264 type of procedure. And so for those that 399 00:15:13,264 --> 00:15:14,164 are indicated 400 00:15:15,184 --> 00:15:17,365 and would need this as a treatment option, 401 00:15:17,825 --> 00:15:20,304 this is a great thing for surgery centers 402 00:15:20,304 --> 00:15:21,044 to market 403 00:15:21,360 --> 00:15:22,259 to their patients. 404 00:15:23,039 --> 00:15:25,200 Yeah. April, thank you so much for for 405 00:15:25,200 --> 00:15:27,120 sharing your insights today. It sounds like there's 406 00:15:27,120 --> 00:15:29,360 a lot of exciting opportunities for ASCs on 407 00:15:29,360 --> 00:15:30,019 the horizon 408 00:15:30,399 --> 00:15:31,860 when it comes to discectomies 409 00:15:32,320 --> 00:15:33,059 and especially, 410 00:15:33,839 --> 00:15:36,480 for patient access. As you mentioned, opening up 411 00:15:36,480 --> 00:15:39,085 more procedures and opportunities for Medicare members, 412 00:15:39,625 --> 00:15:40,524 certainly essential, 413 00:15:40,904 --> 00:15:42,825 in the years ahead. So thank you again 414 00:15:42,825 --> 00:15:44,845 for for your time and your insights today. 415 00:15:45,544 --> 00:15:46,924 Thank you for having me. 416 00:15:47,304 --> 00:15:48,764 And we'd also like to thank 417 00:15:49,080 --> 00:15:50,779 for sponsoring today's episode. 418 00:15:51,160 --> 00:15:53,240 Listeners, you can tune into more podcasts from 419 00:15:53,240 --> 00:15:55,960 Becker's Healthcare by visiting our podcast page at 420 00:15:55,960 --> 00:15:56,460 beckershospitalreview.com.