Patients and their physicians told
Congress on Friday that reforms must be made to the way the Health Care Financing
Administration (HCFA) makes Medicare coverage and payment decisions to ensure
that elderly and disabled Americans have timely access to the latest advances
in medical technology.
The joint hearing of the House Commerce Subcommittee on Health and
Subcommittee on Oversight & Investigations entitled "Patients First: A 21st
Century Promise to Ensure Quality and Affordable Health Coverage," focused
specifically on improving patients' access to new technologies in the Medicare
Kathleen Dziuba, a breast cancer survivor from Ann Arbor, MI, who
testified at the hearing, said she would "ask that Medicare provide
reimbursement for advances" in medical imaging like positron emission
tomography (PET). She avoided an invasive and expensive biopsy surgery after
PET confirmed that an abnormality on her lung was non-cancerous.
Dr. Paul Shreve, a diagnostic radiologist at The University of Michigan
Health System, called on Congress to help eliminate Medicare delays that have
kept many cancer patients from receiving needed PET scans for the past 10
"PET is an example of a major advance in medical technology, an outgrowth
of federally supported medical research, that has been kept from our patients
far too long due to disorganized and indifferent federal agencies such as
HCFA," Shreve said.
Over the last decade PET has become an indispensable tool in detecting
many deadly diseases including multiple forms of cancer and Alzheimer's
disease. However, it remains unavailable to Medicare patients for many key
diseases because of delays and inefficiencies in Medicare's coverage process.
One of America's leading cardiologists, Jeffrey Popma, MD, from Brigham
and Women's Hospital in Boston, said that Medicare patients have faced similar
barriers in gaining access to a breakthrough treatment for blocked coronary
arteries -- intravascular radiation. "The time lag has been entirely too long"
between FDA approval and availability under Medicare. "Patients are in fact
being denied care."
Coronary radiation therapy is performed by temporarily inserting
radiation-emitting seeds into an artery through a minimally invasive catheter.
The radiation affects the blood vessel's cells in a way that helps prevent
reclosure of the artery after angioplasty. By reducing the incidence of
artery reclosure (restenosis) after balloon angioplasty, patients are able to
live healthier lives and avoid serious and expensive complications that often
require follow-up surgery.
However, problems with Medicare reimbursement threaten to create a major
access barrier for the 50,000 beneficiaries each year who could benefit from
this treatment. Due to delays in Medicare procedures, hospitals are
significantly under-reimbursed for intravascular radiation. HCFA will take at
least two years to set an appropriate reimbursement level.
According to the Bush Administration's budget blueprint released this
week: "Medicare is not adapted to 21st Century medicine. Medicare is often too
slow to incorporate technologies and methods of delivering care ... As in
virtually all fields, technological and entrepreneurial innovation are among
the keys to creating more value for the dollar in health care."