Dive Brief:

• The Centers for Medicare and Medicaid Services shared a pair of proposed rules on Thursday afternoon that set rates for physician payments and outpatient procedures.
• The agency issued the 2024 Hospital Outpatient Prospective Payment System and 2024 Physician Fee Schedule proposed rules, both of which are expected to be finalized this fall. 
• Glaukos could be the biggest beneficiary of the proposals among device makers, with an increase in outpatient facility fee rates likely to provide a “meaningful boost” for its iStent device to treat patients with glaucoma, BTIG analyst Ryan Zimmerman wrote in a research note on Thursday.

Dive Insight:

The two payment proposals include reimbursement increases for some medical device companies, and cuts for others.

San Clemente, Calif.-based ophthalmic device company Glaukos is among those who stand to benefit. Its ambulatory surgical center facility fee for the iStent infinite device was nearly doubled from $1,600 to $3,300, and its primary iStent facility fees are expected to increase by 15%, William Blair analyst Margaret Kaczor wrote in a research note. 

“Overall, while this is still a proposed rule and we will look for the finalized version later this year, likely November, we view this update as a nice positive for Glaukos as we believe the launch of iStent infinite has already gone better than expected and the lifted facility fee reimbursement should be another catalyst for adoption in coming years,” Kaczor wrote. 

Shockwave Medical, which makes a device to treat calcified arteries, may see an end to a transitional pass-through payment for outpatient procedures that added $4,700 to reimbursement starting in June of next year, Needham analyst Mike Matson wrote in a research note. This could be partially offset by changes to the physician fee schedule that would increase physician payments for performing coronary intravascular lithotripsy procedures by 25% to 30% compared to a standard angioplasty with a stent, Matson added. 

Cardiac monitoring company iRhythm Technologies would see a decrease in payments under the new physician fee schedule. For two key procedure codes, the proposed payment rates of $220 and $231 were decreased by about 5% from last year, BTIG analyst Marie Thibault wrote in a research note. 

“While some may view the proposal as a minor disappointment, we emphasize that these are proposed rates that are still subject to change with the final rule, expected in late October or early November,” Thibault wrote.