Vol. 1, Issue 43 November 13, 2000

Nov. 7th Vote Leaves Medicare Patients Waiting For Access to Advanced Diagnostic Imaging Technology

As Americans cast their votes on Nov. 7th, a Medicare advisory committee vote in Baltimore highlighted delays in Medicare patient access to an advanced imaging technology called positron emission tomography (PET). On Nov. 7th the Executive Committee of the Medicare Coverage Advisory Committee (MCAC) referred the issue of PET coverage to a separate MCAC panel. The committee meeting indicates that the Health Care Financing Administration finally is moving to consider broader coverage of PET, but it also underscores the years of delays that Medicare patients have faced.

Barriers to Medicare patient access to PET illustrate why Congress and the President must act this year to reduce the long delays in the amount of time it takes Medicare to add new technologies to the program.

PET can save and improve patients' lives and help lower health care costs.


    Brain activity images from UCLA study.
    Source: UCLA
  • PET is a unique, non-invasive imaging technology that can measure cells' metabolic activity and detect cancer and other diseases and conditions early when they are more treatable. In many cases, PET can reduce treatment costs by identifying unsuspected cancer and avoiding unnecessary surgery.

  • A Robert Wood Johnson Foundation-sponsored study called whole-body PET imaging "one of the most exciting developments in imaging for the diagnosis of metastatic and recurrent cancer."

Medicare delays prevent patients from receiving innovative medical technologies and procedures and must be eliminated.

  • Medicare still does not cover PET for many uses that have been covered for years by private insurers.

  • A study released by the Lewin Group earlier this year found that the Health Care Financing Administration often takes 15 months to five years or more to add new technologies to the Medicare program. These delays are the result of problems in Medicare complex coverage, coding and payment procedures for new technologies and procedures.

  • In a recent editorial, The Boston Globe said that the Medicare review process "can make the FDA's like a day at the beach." After FDA approval, the newspaper noted, "new products that haven't been approved by the Health Care Financing Administration can sit on the shelf."

  • The Globe called for "a process that serves both patients and taxpayers well and ensures device makers that their products get a timely and open review."

Congress and the President Must Act Now to Reduce Medicare Delays.

  • Because of problems in Medicare, many older Americans can not gain access to breakthroughs like positron emission tomography that can save and improve their lives.

  • The Medicare Benefits Improvement legislation passed by the House as part of a broader tax and health care reform package includes provisions that will help reduce Medicare delays and ensure that America's seniors can gain access to innovative technologies. The Senate and the President must enact this legislation into law.

    QUOTE OF THE WEEK
    PET "has been covered by private insurers for 10 years but still isn't reimbursable under Medicare."
      -Recent Wall Street Journal editorial.

    ACTION ITEM:
    • Congress and the President must enact the Medicare Refinements measure now so America's seniors and people with disabilities do not have to keep waiting for access to the high quality health care they need.

    • Call your Senators and the White House today and urge them to enact the Medicare Benefits Improvement bill.