Medicare Beneficiaries, Doctors Make ‘Conservative’ Choices
A clinical trial of Medicare beneficiaries that showed mixed results for an emphysema surgery is dissuading patients and doctors from undertaking the procedure, thus reducing Medicare costs, the New York Times reports. Medicare recently has begun requiring beneficiaries to participate in clinical trials to measure the effectiveness of some treatments in an effort to inform coverage decisions.
Policymakers have been surprised by the "outcome of the first and most extensive Medicare trial yet" because it "indicates that the public, armed with the data developed, may make surprisingly conservative decisions," the Times reports. The trial involved a risky but popular operation for advanced emphysema patients that removes diseased sections of their lungs.
The $50,000 surgery was praised by some as a life-saving operation, but other doctors said the surgery was ineffective and "predict[ed] financial doom" for Medicare if it began covering the procedure, the Times reports.
Seeking more information on cost-effectiveness, Medicare decided to require all beneficiaries seeking the procedure to enroll in a clinical trial.
The trial ultimately showed that only certain subsets of beneficiaries who underwent the procedure lived longer or could walk and breathe more easily than those who did not. Based on the study's results, Medicare began covering the procedure for most patients. However, after viewing the data -- which included information on the surgery's high mortality rate -- on their own, patients and doctors "seemed to lose their enthusiasm" for the procedure, the Times reports.
Between January 2004 and September 2005, only 458 Medicare beneficiaries filed claims for the surgery, at a cost to the federal government of less than $10.5 million.
Health economists say the statistics are a "vindication" of Medicare's new policy of requiring clinical trials for some services that have the potential to be "budget-buster[s]," according to the Times.
Steve Phurrough, director of Medicare's coverage and analysis group, said, "It's unusual for the system to work so well."
However, critics -- including many lung surgeons -- said doctors and their patients are viewing the study results too negatively and that many seriously ill beneficiaries are incorrectly forgoing treatment (Kolata, New York Times, 3/3).