Copyright 2000 Globe Newspaper Company
The Boston
Globe
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March 7, 2000, Tuesday ,THIRD EDITION
SECTION: BUSINESS; Pg. C4
LENGTH: 573 words
HEADLINE:
PUBLIC FORUM / CECE NEWMAN AND THOMAS J. SOMMER Cece Newman is executive vice
president of D&R Products of Hudson and is the chairwoman of the
Massachusetts Medical Device Industry Council. Thomas J. Sommer
is the council's executive director.;
A HEALTH CARE FIX FROM WITHIN
BYLINE: BY CECE NEWMAN AND THOMAS J. SOMMER
BODY:
The near failure of the state's largest HMO.
The drug industry's turn-about on Medicare coverage of
prescription drugs. The renewed interest in adopting a patients' bill of rights.
President Clinton's State of the Union focus on the long-term solvency of the
Medicare system.
This year we have seen an
unprecedented amount of attention centered on the state of the nation's health
care system and improving patient access to medical care. State legislatures
have begun sessions in which health care issues will dominate their agendas.
Congress, too, is set to begin work on overhauling the 35-year-old
Medicare system. As it begins its new
session, Congress also will turn its attention, once again, to patients' bill of
rights legislation aimed at improving access to quality health care for
Americans already covered by health insurance. Members of Congress should
carefully examine the outdated policies and methods the Health Care Financing
Administration employs to approve payment and coverage for innovative medical
technologies through the Medicare program.
The HCFA, in
administering medical care for 75 million Americans, is the largest single
purchaser of health care and managed care in the nation. The agency, through
Medicare and Medicaid, directly controls $360
billion in spending and sets the pattern for coverage and payment by private
payers such as Blue Cross/Blue Shield.
Presently, new medical products
and devices must pass two critical reviews before being made available to
patients and health care providers. The first test for safety and effectiveness
is conducted by the Food and Drug Administration, which has made significant
progress in the past few years in modernizing its review process. The second,
lengthier review, is conducted by the HCFA to determine whether a treatment or
diagnostic is reasonable and necessary, and, if so, how much to reimburse the
provider for the product or service.
The current procedures used by the
HCFA have not been updated since the Medicare program was
established in 1965. This antiquated reimbursement system is unable to keep pace
with medical innovations, often delaying the introduction of life-saving and
life-enhancing products for four to five years.
The current HCFA process
is not open or predictable. First, the new medical product must receive a coding
number from the American Medical Association. Coding designation is performed
once a year, and products filed with the AMA after its annual deadline must wait
another 12 months before the HCFA will consider making a decision on whether the
product will be covered by Medicare. Assuming the HCFA approves
a product for coverage, it must still undergo a review process to set an
appropriate payment level for reimbursement purposes. No where at any point in
this HCFA process is there a role for public or technical input.
Federal
lawmakers would take a giant step in improving patient access to new medical
technologies by supporting legislation introduced by Senator Orrin Hatch and
Representatives William Thomas and Pete Stark that would establish a framework
for HCFA's reimbursement decisions.
Health care advances made in this
country are viewed around the globe as the standard for the next generation of
medical treatment. Let's establish a reimbursement system that recognizes this
fact and speeds the delivery of these products to patients and care givers.
LOAD-DATE: March 7, 2000 
