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Medicare Coverage Cuts Decried: Doctors, Heart-Device Industry Say Changes Hurt Patient Care

Posted on: Wednesday, 7 June 2006, 06:00 CDT

By Jim Mccartney, Pioneer Press, St. Paul, Minn.

Jun. 7--Proposed cuts to what Medicare will pay for heart devices could hurt patient care and thwart efforts to improve problem-prone devices, doctors and industry officials said Tuesday.

In April, federal insurance agencies such as Medicare proposed shifting money from high-profit, high-tech procedures, like implanting drug-coated stents and electronic heart devices, to more routine but less-profitable therapies, such as treating pneumonia.

"A bad reform is worse than no reform at all," said Steven Ubl, president of AdvaMed, the Washington, D.C.-based organization that represents the medical-device industry. Ubl made the comments Tuesday morning at a press conference on the proposed reimbursement rates in Washington, D.C. He was accompanied by representatives of several doctors groups and health-research organizations.

AdvaMed's mantra related to the Medicare proposals is: "Too much. Too soon. Too flawed." The industry group acknowledges that changes needed to be made, but argues that they were based on outdated data and convoluted methods. AdvaMed and the other groups said Tuesday they recommend the federal agency hold off from making changes for a year until all the issues can be sorted out.

The U.S. Centers for Medicare and Medicaid Services proposed reimbursement cuts of 33 percent for drug-coated stents, 24 percent for implantable cardioverter defibrillators, and a 40 percent reduction in minimally invasive repairs of heart aneurysms, according to AdvaMed. All of these devices and procedures are big business for Twin Cities-based medical-device companies such as Medtronic, Boston Scientific and St. Jude Medical.

"We are concerned this proposal will have a negative impact on patient care," said Dr. Dwight Reynolds, president of the Heart Rhythm Society, an organization of doctors who implant electronic heart devices.

For example, cardiac resynchronization ICDs have been shown to reduce hospitalization and prolong the lives of heart-failure patients, according to AdvaMed. On average, companies like Medtronic, St. Jude Medical and Boston Scientific, which now owns Guidant Corp., another leading heart-device maker, charge about $31,833 for an ICD. Medicare proposes that hospitals' reimbursement be cut to $23,755, which would mean a loss of $8,078 per implant.

"If they're going to lose money on a procedure, hospitals may shy away from it," Reynolds said. "We fear these changes may result in hospitals restricting access to these devices."

Of course, medical-device firms could help hospitals out by reducing the amount they charge for the devices, Reynolds said. But that's out of the control of doctors and hospitals, he said.

Reynolds also worries that the proposal would "significantly undermine efforts" to track and improve the performance of devices such as pacemakers and ICDs, which have been subject to a series of safety advisories and recalls over the last year. If hospitals are reimbursed at lower rates, they may not devote the necessary staff to register and track the performance history of medical devices, he said.

"If we under-support the payment on these devices, it could affect the integrity of the ICD registry data," Reynolds said.

A spokeswoman for Medicare, who asked not to be identified, said Tuesday that her agency welcomes input on the changes.

"This is what the open comment period is all about," she said.

The period for comments ends Monday. The agency has until Aug. 1 to consider the comments and publish the final rules reflecting the changes.

Jim McCartney can be reached at jmccartney@pioneerpress.com or 651-228-5436.

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Copyright (c) 2006, Pioneer Press, St. Paul, Minn.

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Source: Saint Paul Pioneer Press (St. Paul, Minn.)

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