USA Today Examines Policies Used by Medicare To Determine Coverage for New Treatments
USA Today on Thursday examined "an ongoing dilemma for Medicare: whether to pay for a treatment when data on its effectiveness are uncertain or show it to be of limited value." As the population ages, medical technology advances and Medicare spending expands, the program will increasingly confront questions over what services it should cover, USA Today reports.
Medicare has "never covered every treatment available," but it now covers services and treatments "unimaginable to those who designed the program 40 years ago," according to USA Today. What Medicare covers has an impact beyond the program itself, as many insurers follow the program's lead in deciding what treatments to cover. Tracking results of treatments covered by Medicare is one possible way to slow rising program spending, provided that the research helps determine which treatments are effective, USA Today reports.
However, questions have risen regarding how the information collected from such research would be used. In addition, a medical device lobbying group said in comments submitted last month to CMS that "unfocused or overly broad data-collection efforts could easily limit patient access or provider participation."
"The question is, are we willing to pay for treatments that have a small chance at success?" Peter Neumann, associate professor of health policy at the Harvard School of Public Health, said, adding, "It's true that we are a wealthy country, but whether we admit it or not, there are limits."
Cori Uccello, senior health fellow at the American Academy of Actuaries, said, "The bottom line is, within the next couple of decades, there's not going to be enough money to pay for full benefits."
However, "what may seem like a bleak outlook to a researcher reviewing data" on whether a treatment is effective "may offer hope to a terminally ill patient," USA Today reports. Uwe Reinhardt, a Princeton University economist, said, "Why shouldn't a patient who is very desperate say, 'I'm willing to take a risk of dying from this technology because I have little to lose.'" He suggested that Medicare and other health plans should make coverage decisions that allow for innovation and experimentation, according to USA Today (Appleby, USA Today, 4/21).