This course will describe the reimbursement landscape under PAMA, including how it has shifted during the course of the COVID-19 Public Health Emergency and the challenges expected for 2022 and beyond. Understanding this complex legislation is critical in ensuring that patients have widespread access to diagnostic testing. We will provide a background of this legislation and its genesis, review current timelines and processes, explain which labs are required to report and how often, and examine how new laboratory tests are priced under Medicare.
Paul Gerrard, MD, Vice President, McDermott+ Consulting
Ester Stein, Director, Corporate Reimbursement, Government Affairs, Abbott Laboratories
Nicholas Halzack, Senior Manager, Federal Health Policy & Reimbursement, Roche Diagnostics
Chandra N. Branham, JD, Vice President, Payment & Health Care Delivery Policy, AdvaMed
Tara Burke, PhD, Senior Director, Public Policy & Advocacy, Association for Molecular Pathology
INSTRUCTOR BIOGRAPHIES:
Paul Gerrard, MD, Vice President, McDermott+ Consulting
Paul is a highly regarded physician and healthcare executive with deep experience in both the academic and patient care spaces. He offers clients critical insights across a wide range of clinical areas and healthcare technologies, and provides guidance on Medicare policy and regulatory requirements. Paul also has significant experience in health outcomes research and scientific computing. Before joining McDermottPlus, Paul had a varied career spanning academia, private practice, and Medicare policy. After leaving academia, he established and ran his own medical practice serving patients in addition to advising large institutions on utilization management and quality improvement before becoming a chief medical officer at Palmetto GBA and MolDX director of clinical science leading coverage and payment determinations for new molecular medicine technologies. In this role, he was instrumental in forging consensus among Medicare contractors on emerging and sometimes controversial areas of medicine in a highly visible program, and served as a primary point of contact between MolDX and the Centers for Medicare & Medicaid Services. Paul now works for McDermott+ Consulting assisting manufacturers and health care providers in bringing innovative patient care products to market.
Ester Stein, Director, Corporate Reimbursement, Government Affairs, Abbott Laboratories
Ester Stein is Director of Corporate Reimbursement and reports into Abbott’s Government Affairs’ office which is based in Washington DC. Ester has been employed at Abbott since 2003. Ester is highly knowledgeable in diagnostic reimbursement strategies for traditional diagnostics, molecular and point of care. In her capacity, she has spearheaded efforts to ensure that there is appropriate coverage, coding and payment by public and private insurers for Abbott products in the United States. Ester has also been involved in healthcare economics in the area of oncology, specifically breast and bladder cancer. She Chaired AdvaMed’s Payment Work Group and serves on the AMP Economic Affairs Committee. Ester earned her M.B.A. from Loyola University of Chicago.
Nicholas Halzack, Senior Manager, Federal Health Policy & Reimbursement, Roche Diagnostics
Nick is the Senior Manager of Federal Health Policy & Reimbursement at Roche Diagnostics Corporation. He believes that diagnostics are one of the most crucial elements to improving public health, and that broad access to new diagnostic technologies is based on a solid foundation of reimbursement and access policies. Prior to Roche, Nick worked on federal health policy at the American Society of Anesthesiologists and Nemours Children's Health System. He holds a M.P.H. in Health Policy from The George Washington University and a B.S. in Biological Sciences from Cornell University.
Chandra N. Branham, JD, Vice President, Payment & Health Care Delivery Policy, AdvaMed
Chandra N. Branham, JD, Vice President, Payment & Health Care Delivery Policy
The Advanced Medical Technology Association (AdvaMed)
Chandra Branham, J.D., joined the Advanced Medical Technology Association (AdvaMed) as Vice President, Payment and Health Care Delivery Policy, in 2011. Ms. Branham leads AdvaMed’s policy work in a number of areas, including diagnostics payment, coverage issues, value of medical technology and comparative effectiveness. Prior to joining AdvaMed, Ms. Branham was an associate at large D.C. law firm where she focused on healthcare regulatory and legislative issues involving Medicare coverage, coding, reimbursement and quality for providers and suppliers of Medicare items and services.
Ms. Branham previously was a senior legislative analyst at the Centers for Medicare & Medicaid Services (CMS) Office of Legislation; and early in her career, served as associate director of regulatory affairs at the National Association for Home Care. Ms. Branham has a Bachelor of Science from Drexel University and a J.D. from the George Mason University School of Law.
Tara Burke, PhD, Senior Director, Public Policy & Advocacy, Association for Molecular Pathology
Tara Burke, PhD joined the Association for Molecular Pathology (AMP) staff in 2014 and currently serves as AMP’s Senior Director of Public Policy & Advocacy. Her areas of expertise focus on the regulatory and reimbursement issues affecting molecular pathology. She has a PhD in Biochemistry and Molecular Genetics from The University of Virginia, and completed a postdoctoral fellowship at the NIH. Her training and research in molecular genetics showed her the hope and promise that genetics can bring to improving human health, and she is proud to be able to work towards the realization of this goal.