Vol. 1, Issue 48 December 18, 2000

Medicare Patients Praise Congress for Passing Legislation
to Improve Their Access to Advanced Medical Technology

Medicare patients from across America spoke out to praise Congress for passing legislation to improve access to innovative medical tests and treatments as part of the Medicare Benefits Improvement and Protection Act. The Senate passed the bill on Dec. 15, clearing the way for enactment by President Clinton. The Medicare package includes key provisions of the Medicare Patient Access to Technology Act (H.R. 4395/S. 3082), the Medicare Appeals Act (H.R. 2356) and a provision to improve the outpatient transitional payment program for new technology.

Final passage of Medicare technology access legislation highlights the critical importance of the issue to patients and providers and offers a model of bipartisan action for the incoming Congress and Administration.

Legislation "will make a big difference" for patients by reducing Medicare delays of 15 months to five years or more.

  • As a result of years of Medicare delays in covering positron emission tomography (PET), Rita Rivazzi, a Medicare patient from Glens Falls, NY, had to pay for it herself after a scar was identified on her lung. PET, a breakthrough diagnostic imaging technology, can be used to diagnose cancer at early stages.

  • "Being able to get a PET scan can be the difference between life and death," Rivazzi said. "This bill will make a big difference for cancer patients who need the latest diagnostic tests and treatments."

  • Delores Cook, a Medicare patient from Waldorf, MD, stated: "I'm glad Congress helped other people avoid the problems I have faced in getting the treatment I needed." It took Medicare over five years to cover the ultrasonic bone healing technology that Ms. Cook needed to heal her broken thigh bone and save her leg from amputation.

Legislation will speed up Medicare patient appeals and reduce delays in coverage, coding and payment for innovative medical technologies.

  • To eliminate the often lengthy delays in Medicare coverage decisions, the bill will require Medicare to issue annual reports on the timeliness of its decisions and simplify the agency's complex advisory committee process.

  • To keep Medicare payment systems current with advances in medical technology, the agency will be able to put advanced technologies in "new technology" payment groups if existing payment groups ("diagnosis-related groups") did not adequately recognize the costs of the new treatment. It also must issue a report by April 1, 2001 recommending ways to issue codes for new inpatient technologies more quickly and implement the recommendations by October.

  • Similarly, broad categories of innovative technologies used in the outpatient setting will receive special, temporary payments until adequate data can be gathered. Congress called for this change after HCFA's attempts at implementing the payments based on narrow device brands proved problematic.

  • Medicare problems unique to diagnostics tests and other items reimbursed under "fee schedules" often create serious patient access barriers for these products. The Benefits Improvement and Protection Act requires Medicare to set clear, open procedures for coding and payment and submit a report to Congress recommending steps to assure appropriate reimbursement for innovative diagnostic tests and durable medical equipment.

Medicare bill sets bipartisan model for further technology access improvements in the 107th Congress.

  • Propelled by strong support from patients and health care providers, the Medicare Patient Access to Technology Act garnered strong bipartisan backing over the past several months. H.R. 4395 had 51 cosponsors, about half of which were Democrats.

  • The patient-centered, bipartisan effort provides a model for continued steps to eliminate barriers in Medicare patient access to innovative medical technologies.

  • For example, it can take Medicare 15-24 months to assign a unique procedure code for a breakthrough technology, creating a significant barrier to patient access. The new Administration and Congress can act in the coming year to establish codes for new technologies at the time of FDA review and update codes on a quarterly basis.

QUOTE OF THE WEEK:
"I'm glad Congress helped other people avoid the problems I have faced in getting the treatment I needed."
    - Delores Cook, a Medicare patient from Waldorf, MD

 
ACTION ITEM:
Ensure that HCFA rapidly and fully implements the medical technology access provisions of the Medicare legislation in 2001.

Support further improvements in Medicare patient access to advanced medical technology in the new Congress and Administration.