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Preparing Medicare for the Next 35 Years: As we celebrate Medicare's 35th anniversary this month, Congress must act to fix problems in the program and prepare it for the next 35 years. It can take Medicare four-and-a-half years or more to make a breakthrough technology available to beneficiaries. As a result, many patients can not gain access to the advanced medical technologies and procedures they need. Unless Congress acts, this problem will become more severe in the coming years as the pace of innovation accelerates. Medicare was created for a different health care era. Medicare has benefited over 93 mil. Americans since it was signed into law on July 30, 1965 by President Lyndon Johnson. Yet our health care system and medical technology have changed dramatically since then, and Medicare is not keeping pace. Many of the life-saving and life-improving medical technologies we take for granted today were not available in 1965. Products like artificial heart valves, implantable defibrillators, magnetic resonance imaging, and coronary angioplasty were not yet in use. Medicare is ill-equipped to keep pace with rapid advances in medical technology. Before a new medical technology becomes available to beneficiaries, Medicare must make a coverage decision, assign a procedure code and set a reimbursement rate. Problems in all three of these areas have created lengthy delays and significant barriers to access for Medicare patients. It took Medicare a total of seven years to assign a procedure code and provide adequate reimbursement for coronary stents, which prevent blocked arteries from reclosing. As a result, far fewer eligible Medicare patients received this breakthrough device for several years following FDA approval. For over 10 years, Medicare has not signficantly changed inpatient reimbursement for cochlear implants, which restore hearing to severely deaf people. This is despite dramatic advances in the technology and a New England Journal of Medicine article which found that Medicare patients often were not obtaining the devices due to the reimbursement problems. As noted in a Robert Wood Johnson Foundation report earlier this year, "technological advances are proceeding at an unprecedented speed." Without changes to Medicare, patient access problems will become more severe in the coming years as the medical innovation accelerates. Pending bipartisan legislation will prepare Medicare for the next 35 years. Legislation introduced by Reps. Jim Ramstad (R-MN) and Karen Thurman (D-FL), (H.R. 4395, the Medicare Patient Access to Technology Act) would help eliminate barriers to patient access that have arisen in Medicare's coverage, coding and payment procedures for innovative medical technology. Eliminating coverage delays: To eliminate the often lengthy delays in Medicare coverage decisions, H.R. 4395 would streamline the Medicare advisory committee review process and require Medicare to issue annual reports on the timeliness of its decisions. Eliminating coding delays: Patients face an added barrier as a result of Medicare delays of 15-24 months in issuing the procedure codes that health care providers need for new technologies. The Ramstad/Thurman bill would take several steps to reduce these delays, including requiring HCFA to issue temporary codes at the time of FDA review and update codes on a quarterly basis. Keeping payment up-to-date: To keep Medicare payment systems current with advances in medical technology, H.R. 4395 calls for annual payment updates, improved use of internal Medicare data, broader use of external data, and annual reports on inpatient technology access. Removing access barriers to diagnostic tests: Medicare problems unique to diagnostics tests often create serious patient access barriers for these products. H.R. 4395 requires Medicare to set clear, open procedures for coding and payment decisions for these products, establish formal methods for setting reimbursement rates and create an appeals mechanism.
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