FOR IMMEDIATE RELEASE June 07, 2000

CONTACT: Mary Plock (202) 434-7240

MEDICARE OUTPATIENT TECHNOLOGY ACCESS PROBLEMS MUST BE CORRECTED, HIMA TELLS HCFA OPPS REGULATION COMMENTS FILED, LETTER SENT TO HCFA ADMINISTRATOR

Changes are needed to the Medicare outpatient prospective payment system (OPPS) in order to improve patient access to advanced technologies and promote continued medical innovation, the Health Industry Manufacturers Association (HIMA) says in June 5 comments on the final OPPS regulation.

“To create a Medicare system that promotes patient access, HCFA must keep pace with medical innovation by making timely and appropriate coverage, coding and payment decisions,” HIMA President Pamela G. Bailey said. “The outpatient improvements HIMA is calling for should be applied more broadly to all of Medicare.”

In its comments, HIMA praises the Health Care Financing Administration, the agency that runs Medicare, for taking steps in its final rule towards improved patient access. However, additional important changes must be made, the Association says.

Taking the necessary steps to create an OPPS system that supports patient access and innovation is particularly important, HIMA says, because of the dramatic impact that the new program will have on health care delivery. “Medicare OPPS is a system that will significantly influence, and possibly redefine, a substantial portion of the health care delivery system” and “holds not just the power to alter the kinds of treatments and medical advances available today, but for years to come.”

HIMA highlights a particularly critical problem with HCFA’s implementation of OPPS –the fact that many eligible devices have been left off the list of products receiving the special transitional payments that were mandated by Congress.

HCFA’s decision to make transitional payments based on individual companies’ device brands has created an artificial formulary in which some companies’ products are on the transitional payment list while similar competing products have been left off. The result is that physicians and patients will not be able to choose the technology that is most appropriate for them.

• HCFA must add the remaining eligible devices to the transitional payment list by Aug. 1, HIMA says.
• In addition, the agency should by Oct. 1 create a transitional payment program based on generic device categories rather than individual brands so that the current problem is not perpetuated.

Other recommendations made by HIMA in its comments include:

• Creating a clear and timely process for implementing new technology codes
• Establishing and maintaining adequate payments for new technologies
• Modifying the criteria devices must meet to qualify for transitional payments
• Continuing to limit beneficiary co-insurance on new technology services.

Underscoring the significance of the problems with the OPPS transitional payment program, HIMA’s Bailey sent a separate June 5 letter to HCFA Administrator Nancy-Ann DeParle on the issue. Bailey asked DeParle to commit to correcting mistakes with the transitional payment list for new technologies before OPPS takes effect Aug. 1.

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The Health Industry Manufacturers Association (HIMA) is a Washington, D.C.-based trade association and the largest medical technology association in the world. HIMA represents more than 800 manufacturers of medical devices, diagnostic products, and medical information systems. HIMA's members manufacture nearly 90 percent of the $68 billion of health care technology products purchased annually in the United States, and more than 50 percent of the $159 billion purchased annually around the world.