Bringing women's health products to market is a huge chain. When one link in the chain breaks, the whole chain breaks. This is often what holds women's health innovation back. Part of getting a job in this space is understanding that whole chain for the product or service you are building or working for. There's been a lot of talk about women's health reimbursement this year, but one part of the chain often gets overlooked: diagnosis. It's an important one to ask about when you're interviewing for a women's health job. There's also been a lot of talk the last few weeks about Post Partum Depression or PMDD so I thought this week I'd pull those two together. Here's the deal. For most of the last forty years, if you had PMDD, medicine didn't technically have a diagnosis for you. It sat in an appendix of the DSM as "a condition proposed for further study" until 2013. That's not ancient history, that's most of our careers, and it's the cleanest example I've found of the single link in the reimbursement chain that decides whether anything in women's health ever gets properly paid for, staffed, or funded. The ChainHere's how a condition becomes something you can actually bill for. Medicine has to name it first, give it clinical criteria, put it in the literature, before anyone can even start the process. Then a physician has to be able to diagnose it using that definition. Only after that can a code exist to describe the service. And only once the code exists can anyone, Medicare, a commercial payer, anyone at all, actually pay for it. Every link in that chain has some give to it. Clinical definitions evolve as research catches up. Diagnostic criteria get revised. But the reimbursement link doesn't bend the same way, it's binary, the code exists or it doesn't, and there's no partial credit. Where It Breaks for WomenMost of the time we talk about this problem as if it starts with getting paid. But for women, it usually breaks one link earlier, at diagnosis. Take heart disease, still the number one cause of death for women in this country. Women who show up to the ER with chest pain wait 29% longer than men to be evaluated for a possible heart attack, their symptoms get written off as stress more often instead of triggering a full cardiovascular workup, and even after a heart attack, women are more than twice as likely to die from it. None of that is a coding problem, the codes for cardiac care exist and always have. From what I've learned, the failure happens earlier, at diagnosis, partly because only about a third of cardiovascular clinical trial participants have historically been women, so the diagnostic criteria themselves were built on incomplete data. I started doing some digging into coding for PMDD. I'm definitely not an expert here so if you have a lot of experience here I'd love to talk. Here's what I found so far: even now that it's a recognized diagnosis, confirming it isn't a blood test, it requires two full menstrual cycles of daily symptom charting, real clinical work (can someone actually help me understand this?!). It looks like there still isn't a distinct billable code for that protocol, so it usually gets billed under a generic mood disorder visit instead. It feels like the naming fight only closed a decade ago, and the payment piece hasn't caught up. Why This Is Actually a Career QuestionHere's where I get honest about why I'm telling you this. You don't need to understand CMS to do your job well. But if you're evaluating a company to work for, or trying to figure out why a role feels chronically underfunded, or wondering why your comp in a "hot" women's health space doesn't match the hype, this chain is usually the reason, and most people don't know to check it. Here are a few questions worth asking before you take a job at any women's health company, femtech startup, or clinical practice: | 1. | Is what this company treats or sells actually coded yet, or are they still fighting to get the condition named and defined? If it's still upstream, that's not a red flag by itself, but it means the company's survival depends on cash-pay revenue or investor patience until the naming fight resolves, not on stable reimbursement. | | 2. | If there is a code, when was it last valued, and does the number reflect what the clinical work actually takes? An undervalued code is often why a role or a service line keeps getting squeezed on staffing and comp even though demand is real. | | 3. | Is the role you're interviewing for actually about building the definition and evidence base (research, clinical standards, advocacy), or about operating inside a reimbursement pathway that already exists? Those are genuinely different jobs with different timelines to stability, and it's worth knowing which one you're signing up for. |
|
Here's the uncomfortable part. If a company is still stuck at the naming and diagnosis step, you can be excellent at your job and the company can still struggle, because the constraint isn't execution, it's a committee you'll never sit in and a definition that isn't finished yet. That's not a reason to avoid those companies, some of the most important work in this industry happens exactly there. It just means you should walk in knowing what you're actually betting on. Final ThoughtThe people who get ahead in this industry aren't just the ones doing good clinical or operational work, they're the ones who can look at a company or a role and say, here's where this sits in the chain, and here's what that means for how stable it is. That's a genuinely learnable skill, and almost nobody in women's health has bothered to learn it, which is exactly why it's worth your time. If you want to go deeper on this, join us Thursday for Reimbursement 101, we'll get into exactly how to read this for yourself, whether you're job hunting, building something, or just trying to understand why your own role is funded the way it is. See you Thursday,  |
