4th International

Conference on NOTES®
Working Group 2
Reimbursement
Considerations
 Recommendations from 2008
Reimbursement WG Meeting

1. A robust and validated NOSCAR® registry

2. A NOSCAR funded prospective, randomized trial of
NOTES cholecystectomy
3. A meta-analysis of existing endoluminal experience
4. Encouragement of pooling data on human experience
with NOTES
5. Education and strategy efforts with payers
6. Pursue development of codes for hybrid NOTES
procedures (endoscopic-assisted laparoscopic
cases)
 Big Picture

Over the next 1-2 years, what is the pathway

forward for sharing the cost for developing
NOTES?
 Establish a dialogue with payers

1. Emphasis on NOTES as an evolution

2. Emphasis on the fact that new procedures are not being
developed. We are performing existing procedures
and, therefore, outcomes are known
3. Make clear that in some circumstances even the access
is not new (transvaginal) and in others it is novel
(transgastric approach used in some bariatric
procedures)
4. Emphasize the potential benefits – anecdotal data
 Guidelines for Addressing
Reimbursement Issues

1. Dialogue with payers: goal is reimbursement for existing

laparoscopic cholecystectomy charge
2. Dialogue with the hospital and other stakeholders in the
hospital (anesthesia, contracting dept): partnership to cover
extra cost
- emphasize “loss leader”, PR aspects
3. Management strategy for issue of complications
4. Work with companies to manage equipment cost
 Addressing the Issue of
Complications
1. Develop guidelines for safe practice of advanced MIS/P
2. Analyze existing complication data – US, German, SA
registry
a) nature of complications
b) frequency of complications
c) what is the cost of managing the complications
3. Emphasize not everything is new
a) std procedure
b) accepted access (transvaginal)
4. Segmentation of complications – those that can occur with
CCX performed open or laparoscopic and those
unique to this procedure
5. Emphasize patient selection – low-hanging fruit
 Action Items

1. Develop “starter kit” to help guide dialogue with payers

1. Guidelines outlining criteria which should be met
before doing NOTES-physician and hospital
2. Strategies for addressing complications
3. Mechanisms to approach payers
4. Outcomes to date
2. White Paper II – to include language that emphasizes
NOTES is a novel approach (access) to existing procedures.
We do not have the burden of proving the efficacy of a new
procedure
3. Enable sites to share strategies for payer education
4. Begin dialogue on coding