WASHINGTON — Patient access to technologies such as drug-eluting stents and implantable cardioverter defibrillators may be severely reduced if a Medicare proposal becomes final, physicians and others said at a press conference sponsored by a coalition of device makers, patient advocates, and medical and surgical societies.
The organizations are calling for a 1-year delay in implementation of the Centers for Medicare and Medicaid Services' April proposal to overhaul diagnosis-related group calculations and reduce reimbursement to hospitals for a variety of mostly cardiac procedures. If not delayed, the Hospital Inpatient Prospective Payment System rule would become final in late July or early August and go into effect in October.
“If adopted, this proposal would implement the most dramatic change in hospital payment rules in nearly 20 years,” said Stephen J. Ubl, president and CEO of the Advanced Medical Technology Association (AdvaMed), a medical device lobbying group.
CMS is seeking to move from a charge-based system to a cost-based system. AdvaMed is not opposed to the switch, but CMS's methodology—which will rely on outdated information—is flawed, Mr. Ubl said. For instance, 2007 payments would be based on 2003 cost reports.
Dr. Mark A. Turco, an interventional cardiologist at Washington Adventist Hospital in Takoma Park, Md., who spoke on behalf of the Society for Cardiovascular Angiography and Interventions, noted that drug-eluting stents were not available for most of 2003.
CMS has proposed slashing stent payments by 23%–33%. As a result, the society “is worried that hospitals will inappropriately discourage the use of the newest and most costly technologies,” Dr. Turco said.
He also mentioned that as it stands, CMS pays for implantation of only one drug-eluting stent per vessel and that some hospitals are already limiting how many stents can be used, but that surgeons are pushing those limits—the mean is 1.4–1.7 stents per procedure right now, he said. The concern is that if CMS clamps down further, it might be very hard to use more than one stent in a vessel, even if it's needed.
Thoracic surgeons are concerned the cuts will lead hospitals to put the squeeze on specialty teams that provide invaluable assistance and care, especially in emergent or urgent procedures like transplantation or replacement of infected valves, said Dr. Frederick L. Grover, president of the Society of Thoracic Surgeons.
In a statement, Dr. Dwight W. Reynolds, president of the Heart Rhythm Society, said the proposed cuts for implantable cardioverter defibrillators (22%–24%), pacemakers (12%–15%), and ablations (28%), would not only discourage these procedures, but might also hinder quality improvement efforts. Hospitals could reduce resources devoted to a largely voluntary collection of outcomes data, he said.
The American Hospital Association alerted its members in early June that it did not oppose a return to cost-based payments, but said CMS's methods are flawed. The AHA board recommended a 1-year delay in the rule.
Device maker Medtronic Inc. urged physicians in a letter to write to CMS to oppose the cuts. The new scheme “could reduce patient access to interventional procedures,” wrote Scott R. Ward, president of Medtronic Vascular. “We are confident that a substantive and comprehensive response to the CMS proposal will have an impact,” he wrote.
Dr. Turco noted that the changes will affect care for all patients. “If implemented, these changes may very well make it difficult for physicians to deliver to Medicare beneficiaries, and all patients, the innovative medical care that has led to declines in mortality from cardiovascular disease.”
The cuts would hinder care for all patients, not just those on Medicare, Dr. Mark A. Turco said. Vivian E. Lee/Elsevier Global Medical News