FOR IMMEDIATE RELEASE August 07, 2000

CONTACT: Jeff Ezell 202/434-7243 Mary Plock 202/434-7240

MEDICARE PATIENT ACCESS DELAYS TOP FIVE YEARS, NEW STUDY FINDS

WASHINGTON, D.C. - Medicare often takes between 15 months and 5 years - and sometimes even longer - to make innovative medical technologies and diagnostics fully available to beneficiaries, according to a report released today.

The report, The Medicare Payment Process and Patient Access to Technology, for the first time comprehensively analyzes the problems in Medicare’s procedures for making new technologies available to beneficiaries and describes with quantifiable information their impact on patient access and utilization. Published by The Lewin Group, the report finds that as a result of problems in Medicare, potentially thousands of patients could go without an important new technology in the period of time required to obtain coverage.

“The findings of this report merit careful consideration by anyone concerned with the quality of health care received by America’s seniors,” said Pamela G. Bailey, president of AdvaMed, the Advanced Medical Technology Association. “The report’s validation of the hurdles in the Medicare system add a new sense of urgency of the need to make changes that will give Medicare beneficiaries timely access to life-saving and life-improving medical technologies.”

The Lewin Group’s report finds that delays in patient access are due to Medicare’s tremendously complex, uncoordinated and time-consuming steps that a new technology must go through - coverage, coding and payment - before it becomes available to Medicare beneficiaries.

The report illustrates problems with Medicare in a series of case studies on four specific technologies - bone densitometry (DEXA), cochlear implants, transurethral needle ablation and implantable cardioverter/defibrillators. Examples like bone densitometry and cochlear implants show the impact Medicare problems have on patient access.

• Ten million Americans have osteoporosis - eight million of them are women. Dual-energy x-ray absorption technology (DEXA) is an important advance in diagnosing osteoporosis, yet Medicare took seven years to approve coverage of DEXA. It finally took an act of Congress to provide this technology to Medicare patients.
• Cochlear implants can restore hearing to people with severe hearing loss. Medicare patients face significant barriers to receiving cochlear implants because Medicare has not updated its inadequate reimbursement for the device for 14 years. Proportionally, of all the people who could benefit from cochlear implants, far fewer Medicare patients than non-Medicare patients have received them. Fifty four percent of all patients eligible to receive cochlear implants are of Medicare age, but only 12 percent to 15 percent of implant recipients are Medicare patients.

Importantly, The Lewin Group also points out that small companies are particularly vulnerable to hurdles posed by Medicare’s uncoordinated and time-consuming processes. Small medical technology innovators often have fewer resources to invest in gathering additional data beyond that required by FDA, pursuing national or local coverage decisions, and obtaining coding and adequate payment. As a result, small companies may shift the focus of new product development to less innovative technologies that may have the most predictable routes to coverage and payment.

“Small companies are an important source of innovation, particularly for breakthrough technologies,” said Bailey. “Medicare’s lengthy and uncoordinated process for bringing medical technologies to patients has important implications for these firms.”

The Lewin report provides valuable insight to Congress as it considers changes to Medicare through amendments to the Balanced Budget Act of 1997. AdvaMed supports enactment of the Medicare Patient Access to Technology Act (H.R. 4395), which would address many of the policy issues in the report. The bill was introduced earlier this year by Reps. Jim Ramstad (R-MN) and Karen Thurman (D-FL) to ensure that Medicare beneficiaries gain timely access to the innovative medical technologies and procedures they need.

Click here for the key findings of the report.
To read summaries of the case studies, click on the below titles:

Transurethral Needle Ablation.
Bone Density Scanning.
Automatic Implantable Defibrillators.
Cochlear Implants.

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AdvaMed, the Advanced Medical Technology Association, (formerly the Health Industry Manufacturers Association) represents more than 800 innovators and manufacturers of medical devices, diagnostic products and medical information systems. Our members produce nearly 90 percent of the $68 billion health care technology products consumed annually in the United States, and nearly 50 percent of $159 billion purchased around the world annually.