Access Pathway

Program three of three

We open the door. Proven treatments and devices that can't get paid for. We publish the evidence and drive the coverage.

The first instance is my own reconstruction.

The implant is FDA-cleared. The surgeons are here in Salt Lake. The literature runs five hundred plus cases abroad. And still: no billing code, no coverage, years of fighting for every inch.

That is not a technology failure. It is a pathway failure. A cleared device that nobody can bill for is, to a patient, the same as a device that does not exist.

Andrew Piskadlo, President and CEO

How the walk works

Three steps, and none of them are new.

This has been done before. Partial-hand prostheses got their own codes after one clinician-led push, and they are billable to Medicare as of this April. The path exists. Almost nobody walks it, because walking it is unglamorous, slow, and belongs to no single institution.

Step one

Publish the case

Find who needs it and prove it. Build the evidence record to a standard that survives review, then put it in the literature where a payer has to reckon with it.

Step two

Drive the code

A procedure nobody can bill is a procedure nobody performs. Take the evidence through the committees that assign the code, and stay in the room for the years it takes.

Step three

Open the coverage

The code is the lock. Coverage is the door. Once both open, the treatment reaches the people it was cleared for, and it stays reachable without us.

Two locks on the door

Regulation and awareness. We open both: find who needs it, prove it, code it.

This is not only medicine. The same walk runs anywhere a proven thing is stranded by the rules meant to govern it. A treatment, a device, a material, a way to generate power: it works, it may already be cleared or demonstrated, and still no one can adopt it, because the code, the standard, or the coverage that would let them does not exist yet. Wherever a regulated field lets a working technology sit unreachable, the sequence holds. Publish the evidence, drive the code or the standard, open the door. The subject changes. The steps do not.

Why almost nobody walks it. Each step belongs to no single institution and pays off years after the work. A clinician has patients to treat, not committees to sit on. A maker sells the cleared product and moves to the next one. So the proven thing waits, sometimes a decade, for someone whose whole job is to carry the evidence from the bench to the code to the coverage, and to stay in the room until the door opens. That is the job PDTI takes, and once the door is open the treatment stays reachable without us.

Fund the pathway Bring us a stranded technology