CMS Approves Expanding Medicare Coverage for Implantable Cardiac Defibrillators
CMS Administrator Tom Scully on Friday announced that the agency will expand the number of Medicare patients who qualify to receive implantable cardiac defibrillators, limiting coverage to patients who appear the most likely to benefit from the device, the New York Times reports. (Petersen, New York Times, 6/7). ICDs detect an abnormal heart rhythm and automatically restore normal rhythm in people who have had heart attacks. Medicare currently covers ICDs for 27,000 beneficiaries who have had heart attacks and are considered at the highest risk for sudden death because of abnormally rapid heartbeats. However, a March 2002 study found that a larger pool of patients might benefit from the devices. The study showed that the devices reduced death rates by 31% for patients who had had heart attacks and impaired blood-pumping ability but not fast heartbeats (California Healthline, 2/13).
ICD manufacturer Guidant, which sponsored the study, requested that CMS expand coverage to all patients found to benefit from the ICD. However, in an "unusual move," CMS decided to expand coverage of the procedure, which costs about $35,000, only to a subgroup of patients that the agency believes stands to benefit most from the implant, the Washington Post reports (Brown, Washington Post, 6/7). Scully said that the decision will make an additional 10,000 patients per year eligible to receive Medicare coverage for the device, the Wall Street Journal reports. Some cardiac experts have "accused Medicare of trying to save money" by limiting the coverage expansion, according to the Journal (McGinley/Callahan, Wall Street Journal, 6/9). However, Scully said that the high price of the devices was not a factor in the agency's decision, adding that the agency determined that the potential benefits of the device did not outweigh the risks for all categories of patients that the companies sought to include. CMS may further expand coverage of the devices next spring after the results of another clinical trial are released, Scully said (New York Times, 6/7).
In other Medicare news, CMS on Thursday announced that it will change the way it reimburses hospitals for outlier payments, which reimburse for unusually expensive care, the Los Angeles Times reports. Under the new rules, which will take effect in October, CMS will target "inflated billing practices," and hospitals with "histories of inappropriate billing" will not be paid until the cases are reviewed. The new rules are a response to hospitals such as those run by Santa Barbara-based Tenet Healthcare, the nation's second largest hospital chain, which "reaped huge profit" from such cases (White, Los Angeles Times, 6/6). The HHS Office of Inspector General last November announced that it would audit Tenet's hospitals to determine whether the company properly billed Medicare for outlier payments (California Healthline, 5/28). Tenet has "repeatedly denied" engaging in any illegal activities, according to the Times (Los Angeles Times, 6/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.