Medicare To Expand Coverage for Expensive Carotid Stent Procedure, CMS Announces
CMS on Thursday announced that Medicare will to begin to cover an expensive procedure for certain beneficiaries at high risk for stroke because of blockages in their carotid arteries, the AP/Contra Costa Times reports. The procedure involves the insertion of a balloon to expand carotid arteries in the neck followed by a stent to prevent future blockages.
According to CMS, Medicare will expand coverage for the procedure to beneficiaries with at least 70% blockage in either of their carotid arteries who are considered at high risk for carotid surgery. CMS officials said that Medicare will limit the number of health care facilities and surgeons who can receive payments for the procedure to "ensure optimal patient outcomes" and improve evaluation of health care provider performance. Medicare also will provide payments for additional clinical trials that could lead to an additional expansion of coverage for the procedure.
"We are working with health professionals and product developers to reduce the incidence of stroke in our population," CMS Administrator Mark McClellan said.
A CMS official would not estimate the number of Medicare beneficiaries eligible for the procedure or the cost to the program. Ralph Sacco of the American Stroke Association said that tens of thousands of Medicare beneficiaries might qualify for the procedure, adding, "It's a pretty big deal."
However, Barry Katzen, director of the Baptist Cardiac and Vascular Institute in Florida, said of the expanded Medicare coverage for the procedure, "It really doesn't cover most patients treated today with carotid surgery. Most patients treated today don't have warning signs for stroke, but they do have a narrowing of the artery going to the brain" (Freking, AP/Contra Costa Times, 3/18).
In related news, a House Ways and Means Health Subcommittee hearing on Thursday considered the recent increase in Medicare costs for medical imaging services.
According to Mark Miller, executive commissioner of the Medicare Payment Advisory Commission, Medicare payments to physicians for medical imaging services increased by more than 60% between 1999 and 2003, from $5.7 billion to $9.3 billion. Over the same period, Medicare payments for diagnostic imaging services increased by 45%, compared with 22% for all physician services, Miller said.
He added that Medicare payments for MRI increased by 99% between 1999 and 2003. In addition, over the same period, Medicare payments for nuclear medicine increased 85%, and payments for CT scans increased by 82%, Miller said.
In a March 1 report to Congress, MedPAC recommended that CMS require providers who perform medical imaging services and physicians who interpret the results to meet quality standards to qualify for Medicare payments and improve coding edits for such services.
At the hearing on Thursday, experts were "split" over the recommendations, CQ HealthBeat reports. James Borgstede, chair of the American College of Radiology Board of Chancellors, said one problem is that physicians who are not radiologists currently perform a large number of medical imaging services. "The real harm is excessive exams and unnecessary exposure to radiation leading to a missed diagnosis, which can result in additional patient injury or even patient death."
However, cardiologists and other physicians said that they perform medical imaging services in their offices and have the ability to interpret the results properly. "When I conduct images in my office, I can read them immediately to expedite diagnosis and begin treatment," Kim Allan Williams, a cardiologist who testified on behalf of the Coalition for Patient Centered Imaging, said.
Rep. Pete Stark (D-Calif.) said that the testimony demonstrated "a little bit of a turf war" and recommended that experts work with lawmakers to determine whether the medical imaging industry requires federal regulation (CQ HealthBeat, 3/17).