Case Studies

CMS Reimbursement

Goal:

Gain access to CMS decision-makers and explain the complexity of a procedure in order to increase the current reimbursement rate.

results:

  • Explained criteria and process for changing the reimbursement rate, then created the strategy of targeting CMS and Capitol Hill to educate, develop champions for the cause, and influence the process.
  • Built a coalition of medical professionals to share their expertise and demonstrate the complexity and value of the procedure.
  • Coached the company on who to target, what messages to use, and when to time meetings and interactions.
  • Organized meetings with CMS to review medical publications and data on the procedure.
  • Secured dozens of calls, letters and communications to CMS from Capitol Hill and other established medical professionals explaining the appropriate cost for the procedure and need for increased rate.
  • CMS increased the rate 5X the initial rate.