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Heart Doctors Oppose Medicare Pay Changes

Posted on: Tuesday, 6 June 2006, 17:00 CDT

By Susan Kelly

CHICAGO (Reuters) - Proposed changes in the way the U.S. Medicare health insurance agency reimburses hospitals would jeopardize doctors' ability to care for patients with life-threatening cardiac conditions, several heart specialists said on Tuesday.

The changes proposed by the U.S. Centers for Medicare and Medicaid Services, which runs the Medicare health program for more than 43 million elderly and disabled people, would cut reimbursement payments and lead to reduced hospital staffing for critical cardiac procedures, said doctors opposed to the plans who spoke at a news conference in Washington, D.C.

Such cutbacks could reduce patients' access to such life-saving technologies as implantable cardioverter defibrillators (ICDs), which shock racing hearts back to normal rhythm, and drug-coated stents to clear blocked arteries.

CMS in April proposed the rule changes, which are aimed at redistributing funding for in-patient care from complex procedures, such as heart device implants, to treatments that are more routine and considered underfunded, such as pneumonia.

The government's intent is to eliminate reimbursement inequities that allow specialty hospitals to prosper at the expense of general hospitals. But the effect could be to limit use of the most advanced medical technologies available to treat heart patients, the doctors said.

"CMS' proposed changes to the hospital in-patient payment system will significantly hinder our mission to improve care and advance treatments for heart rhythm disorders, such as sudden cardiac arrest and atrial fibrillation," said Dr. Dwight Reynolds, president of the Heart Rhythm Society.

The new CMS payment methodology would slash payments for ICDs as much as 24 percent, pacemakers by 15 percent, drug- coated stents by 33 percent and cardiac ablation surgery used to treat atrial fibrillation -- the most common abnormal heart rhythm -- by 28 percent.

The changes would affect such companies as Medtronic Inc., St. Jude Medical Inc., Boston Scientific Corp. and Johnson & Johnson.

Cutting the payment for drug-eluting stents by a third would most impact patients whose artery blockages call for placement of multiple overlapping stents, because current reimbursement is based on an average of 1.4 devices per procedure, said Dr. Mark Turco, of the Society for Cardiovascular Angiography and Interventions.

"It would be terrifying to me that, as a physician, I would be limited as to the number of drug-eluting stents or any of newer technologies coming down the pike," he said.

A key flaw in the proposal is its use of cost data from 2002 and 2003, before the introduction of drug-eluting stents revolutionized treatment of coronary artery disease, said Stephen Ubl, president of the medical device industry trade group AdvaMed.

He said Medicare is proposing the most drastic changes in hospital payment rules in 20 years without allowing adequate time for the industry to analyze the plan and provide input.

A comment period on the proposed changes, which would cover in-patient hospital stays in 2007 and 2008, ends on June 12. A final decision by Medicare is expected in early August.

"The proposed rule in its current form is too much, too soon and too flawed. It does not increase the accuracy of payment," Ubl said.

Medtronic spokesman Rob Clark said Medicare must meet its goal of controlling costs without limiting patient access to medical technology.

"There's a recognition here that some of the fundamental data and some of the methodology that was used to come up with the proposal has problems with it," he said.

Source: REUTERS

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