Podcasts | March 16, 2021 |

Digital Transformation in Pathology / Reimbursement for digital pathology in the clinic – how does that work?

Digital Transformation in Pathology podcast by Dr Aleksandra Zuraw from Digital Pathology Place – sponsored episode by Visiopharm.

In this episode Dr Aleksandra Zuraw looks at the complicated maze of digital pathology reimbursement and how to align it with its value. She speaks to Visiopharm’s Chief Clinical and Regulatory Officer, Esther Abels, who contributed to establishing a regulatory pathway for digital pathology.

Esther tells us about the importance of supporting the understanding of the health economic impacts and patient improvements.

“We need to articulate what the service is that we provide and what is uniquely provided to the individual patient. And we need to identify the data we need to figure this out and to make sure that not only the fee goes for the technology, component of the code, but also to the physician’s fee. I think we should be defining key endpoints and outcomes. We have to outline these relevant to demonstration of the value, and of the technology.”

Esther Abels, chief clinical and regulatory officer, Visiopharm

Medical tests and procedures can get reimbursed. The basis of the reimbursement are the Current Procedural Terminology (CPT) codes developed by the American Medical Association (AMA).

But how can a health care provider get such code for their procedure? And how can it be obtained for digital pathology which is so much more complex than a group of tests or procedures that could be reimbursed on a fee-for-service basis?

According to Esther, to align the digital pathology reimbursement with its value the fee-for-service paradigm needs to shift to a value-based reimbursement strategy.

To determine the real value of digital pathology for patient care we need to

  • Articulate the services provided and define their added value and uniqueness in patient care (e.g. risk assessment, improvements in responses to therapy, delay in disease progression),
  • Gather data relevant to support the claimed added value (e.g. cost effectiveness data),
  • Ensure that the reimbursed fee is based on a combination of technology use and physician involvement,
  • And identify the key values relevant for the decision-making stakeholders.

Limited work has been done in this area so far, but if we look into the existing care decision-making and treatment patterns as well as analyze the claims for existing codes in the payers’ databases, we will be able to identify key datasets where digital pathology could make a difference and use this information to start applying for new CPT codes more aligned with digital pathology value.

To analyze what steps would need to be taken to prove to the payers that a digital pathology test deserves reimbursement, let us take a tangible example of the Visiopharm’s AI-assisted metastasis detection in Lymph nodes application.

This application has a technical, artificial intelligence-based screening component and a pathologist’s reviewing component. Currently in order to assess the presence or absence of cancer metastasis in lymph nodes several (even up to 60) sections of lymph nodes need to be visually evaluated by a pathologist. Finding a metastasis in one of those slides is sufficient to make the diagnosis, but regardless all the other slides need to be reviewed as well.

One of the benefits of the AI application would be to save the pathologist’s time, but reducing cost is not the only added value of such application. The value proposition here lies in adding value to patient care.

In this case using a computer algorithm for this task would increase consistency and precision increasing the overall quality of the slide review. AI-aided slide review for metastasis would result in faster turn around not only for the cases where it was used but also for other cases, as the time for visual review could now be used for evaluation of other cases or spending more time on more complex cases again increasing the quality of patient care.

Faster diagnosis means faster access to treatment, which often means shorter treatment times. Every time we are able to point out and overcome limitations in the current standard of care with digital pathology applications we have both a legitimate reason to get reimbursed for its use and an incentive to fight for it if we want to make the patients’ lives better.

Runtime: 31 minutes

If you enjoyed this episode, you might also like other episodes in our Digital Transformation in Pathology series:

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