Copyright©September
2000 IMDA
Medicare often takes between 15 months and 5 years -- and sometimes even longer -- to make innovative medical technologies and diagnostics fully available to beneficiaries, according to a report by The Lewin Group, Falls Church, VA.
The report, “The Medicare Payment Process and Patient Access to Technology,” says that delays in patient access are due to the complex, uncoordinated and time-consuming steps that a new technology must go through -- coverage, coding and payment -- before it becomes available to Medicare beneficiaries.
The report illustrates problems
with Medicare in a series of case studies on four specific technologies –
dual-energy X-ray absorption technology for diagnosing osteoporosis, cochlear
implants, transurethral needle ablation and implantable
cardioverter/defibrillators.
Ten million Americans – eight million of them women – have osteoporosis. Dual-energy X-ray absorption technology is an important advance in diagnosing the disease, according to the report, yet Medicare took seven years to approve coverage of it.
Meanwhile, cochlear implants can restore hearing to people with severe hearing loss. Even so, Medicare patients face significant barriers to receiving such implants because Medicare has not updated its inadequate reimbursement for the device for 14 years, according to The Lewin Group.
Proportionally, far fewer
Medicare patients than non-Medicare patients have received cochlear implants.
Fifty four percent of all patients eligible to receive cochlear implants are
Medicare age, but only 12 percent to 15 percent of implant recipients are
Medicare patients.
Patients aren’t the only ones who are suffering, says The Lewin Group. Small manufacturers are particularly vulnerable to hurdles posed by Medicare's uncoordinated and time- consuming processes. Small medical technology innovators often have fewer resources to invest in gathering additional data beyond that required by the FDA, pursuing national or local coverage decisions, and obtaining coding and adequate payment. As a result, small companies may shift the focus of new product development to less innovative technologies that may have the most predictable routes to coverage and payment.
The report was grist for the mill for AdvaMed (formerly the Health Industry Manufacturers Association), which supports enactment of the Medicare Patient Access to Technology Act (H.R. 4395), intended to address many of the policy issues in the report. The bill was introduced earlier this year by Reps. Jim Ramstad (R-MN) and Karen Thurman (D-FL) to ensure that Medicare beneficiaries gain timely access to the innovative medical technologies and procedures they need.
Key findings of The Lewin Group report and summaries of the case studies are available on www.AdvaMed.org/publicdocs/keyfindings.pdf.
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