CAT III to CAT I Shon and Adi Meeting

Meeting Overview

A comprehensive discussion on the draft application for the Society of Interventional Radiology (SIR) involvement was conducted.

Objective

The primary objective is to ensure the application meets all specified requirements, gather substantial evidence, and finalize preparations for submission in June. This includes anticipating multiple meetings leading up to the final submission scheduled for September.

Application Preparation

  • Current Task: The team is to send the draft application and key components to SIR for detailed review.

  • Importance: It is crucial to address the required levels of evidence that SIR expects.

  • Patient Demographics: Specifics on patient demographics and the widespread use of the procedure need to be thoroughly prepared.

  • Prior Conversations: Emphasized the importance of earlier discussions with SIR in order to foster understanding prior to the upcoming meeting.

Expectations from Team Members

  • Clarity on Roles: A request has been made for clarity regarding each team member's role and responsibilities for the impending meeting.

  • Education of SIR: There is an emphasis on effectively educating SIR about the intricacies of the procedure and providing comprehensive answers to detailed inquiries.

Key Points to Communicate

  • Explanation of the TADV Procedure:

    • Steps Involved: Thoroughly outline the steps involved in the TADV procedure, providing the rationale for each constituent step.

    • Patient Fragility: Stress the importance of understanding patient fragility and its impact on procedure outcomes.

  • Patient Population Insights:

    • An analysis of the characteristics of typical patients must highlight their comorbidities and health conditions.

    • Discussion should include the slow-paced nature of procedures due to patient conditions, providing necessary context for SIR.

  • Typical vs. Atypical Procedures:

    • Justification for the duration of procedures needs to be clearly articulated.

    • An understanding of coding implications in relation to typical practices must be demonstrated.

    • Examples should be discussed to clarify these differences for SIR's audience.

  • Key Opinion Leader (KOL) Involvement:

    • Plans should be formulated to involve a respected KOL to bolster credibility during the presentation.

    • The chosen KOL must be well-versed in the specific procedure to provide informed insights.

SIR Presentation Tips

  • Procedural Steps: A focus on clearly explaining the procedural steps involved is vital.

  • Duration Justification: Illustrate why the procedures generally take longer than those typically performed.

  • Typical vs. Atypical Definitions: Define what constitutes typical versus atypical procedures within the context of Medicaid coverage.

  • Questioning Preparation: SIR should be prepared for a barrage of frequent questions pertaining to the application and procedure details.

Widespread Use Evidence

  • Assert the need for robust data to validate the widespread use of the procedure:

    • Highlight confidence in the numbers of both patients and physicians supporting the procedure's efficacy.

    • It is essential to utilize varied methodologies for collecting data to support ongoing claims.

    • Present regional patient volume statistics obtained from Medicare data analyses.

    • Address the low response rates in prior surveys and strategize on approaches to navigate these challenges effectively.

Code Descriptor Discussion

  • Clarify where the CPT code for the procedure will be positioned within the coding system.

  • Drafting a concise descriptor that encapsulates the integral elements unique to the procedure:

    • Provide a well-defined explanation of the procedure, highlighting any specific actions unique to it.

    • Include an explanation of how certain actions are bundled under this code.

    • Consider including elements that accentuate the procedure's uniqueness while deliberately avoiding proprietary language.

Meeting Format

  • Expect an informal tone throughout the meeting, allowing for candid conversations addressing any concerns.

  • The aim is to foster an open dialogue rather than a strictly structured presentation.

Upcoming Actions

  • Ensure the application is comprehensively prepared and meets all guidelines.

  • Continuous dialogue with SIR is required leading up to the submission and the September panel review.

  • Collect extensive data on physician and patient volumes to advocate in support of the application.

Conclusion

In conclusion, the emphasis must be placed on maintaining clarity and preparedness for effective communication with SIR. The ultimate goal is to instill confidence in the application and proactively address any concerns that may arise during discussions with SIR.