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Medicare News for Senior Citizens
Storm of Protests Develops Over Medicare Changes to
Payment Rule
By 2008 the proposal
will reduce pay - 11.7% for cardiac hospitals, 9.4% for orthopedic
hospitals and 7.2% for surgical hospitals
 June 7, 2006 - It has taken awhile for the
opposition to the new hospital Inpatient Prospective Payment Rule
proposed by Medicare in April, but maybe because the complete rule is
1192 pages long. The Society for Women's Health Research was joined by
several opposing groups in a news conference saying the changes will
have a chilling effect on research and development of devices and
diagnostics that are gender specific. KaiserNet.org reports others are
joining the opposition.
 Groups
Oppose Proposed Revisions to Medicare Reimbursements for Medical Devices
Medical device makers, specialty hospitals and some
patient groups are urging
CMS to
delay implementation of a proposed change in reimbursement policies that
would reduce payments for drug-eluting stents, implantable
defibrillators and other medical devices,
CQ HealthBeat
reports (Carey, CQ HealthBeat, 6/6).
CMS, which proposed the change in April, said the
rule would close loopholes used by specialty hospitals -- such as
cardiac, orthopedic and surgical facilities -- and reduce costs.
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By 2008, the proposed rule would reduce
reimbursements by 11.7% for cardiac hospitals, 9.4% for orthopedic
hospitals and 7.2% for surgical hospitals (Kaiser
Daily Health Policy Report, 4/14). The proposed rule is part
of a larger Medicare plan that would replace the current charge-based
reimbursement system with a cost-based system.
The deadline for public comments on the proposal is
June 12. A final plan will be announced in August, and implementation is
planned for October (Kamp, Dow Jones, 6/5).
Concerns
According to Stephen Ubl, president and CEO of
AdvaMed,
which represents medical device makers, the proposed rule would reduce
reimbursements for stents by more than 30% and for defibrillators by
almost 25%.
Ubl and Dwight Reynolds, president of the
Heart Rhythm
Society, said implementation of the plan should be postponed
for one year to allow interested parties more time to assess the
proposal. Ubl said the proposal is based on data that is up to five
years old, adding, "The proposed rule in its current form is too much,
too soon and too flawed."
Reynolds said, "We recommend that these changes be
deferred, so that all stakeholders can better understand the impact and
allow CMS to develop an accurate system that will continue to allow
patient access to the therapies and services they need" (CQ HealthBeat,
6/6).
Meanwhile, Scott Ward, president of
Medtronic's
vascular business, sent a letter to doctors urging them to tell CMS and
Congress that the proposal is "flawed and should be rejected until the
data and methodology are corrected."
Ward said that the rule has "technical errors and
assumptions that worsen the overall payment cuts to cardiology" and that
it could "reduce patient access to interventional procedures."
Daniel Starks, president and CEO of
St. Jude Medical,
has said that the proposal is "flawed" and that the deadline for public
comments is too soon. "We don't expect the current draft proposals to
end up defining the level of reimbursement," Starks said (Dow Jones,
6/5).
DRG Payments
The
American Hospital
Association also is opposing part of the CMS proposal that
would create a cost-based reimbursement system for diagnosis-related
groups, CQ HealthBeat reports (CQ HealthBeat, 6/6). The rule would
increase Medicare reimbursements for inpatient services at acute care
hospitals by 3.4%, or about $3.3 billion, in fiscal year 2007.
In addition, the rule would base the weights
assigned to DRGs on hospital costs rather than charges and would adjust
DRGs for patient severity to "eliminate biases in the current DRG system
arising from the differential markup hospitals assign for ancillary
services among the DRGs."
The rule marks the first step in a two-step process
for reform of the DRG system. The second step, scheduled for FY 2008,
would replace the system of 526 DRGs with either the proposed 861
consolidated severity-adjusted DRGs or an alternative security-adjusted
DRG system developed in response to public comments submitted to CMS on
the issue (Kaiser
Daily Health Policy Report, 4/18).
On Monday, AHA officials sent a letter to its
members saying, "Questions remain about the concepts and methodology
used to create the changes and about whether the changes will create a
better payment system." AHA is pushing CMS to postpone the changes for
one year and phase in any payment changes over three years.
Administration Comments
Herb Kuhn, director of the
Center of
Medicare Management at CMS, said the proposals were "designed
to more accurately reflect the cost of care" and correct "notable
distortions" in the current reimbursement system. He added, "We really
want to make sure we pay as accurately as possible for inpatient
hospital services" (CQ HealthBeat, 6/6).
Statement from President of Society
for Women's Health Research
June 7, 2006 - Society for Women's Health Research
president and CEO Phyllis Greenberger, M.S.W., issued the following
statement today about Medicares proposed hospital Inpatient Prospective
Payment Rule at a joint press conference held at the National Press Club
with AdvaMed, the Heart Rhythm Society, the Society for Cardiovascular
Angiography and Interventions, the Sudden Cardiac Arrest Association,
and the Society of Thoracic Surgeons. A public comment period on the
rule ends on June 12.
When the Society was established in 1990, there
was little or no attention to differences between women and men in most
areas of health from heart disease to cancer because so few
researchers had ever looked into it. Over the last 15 years, we have
effectively lobbied the public and private sectors for more research
into how women are affected differently than men in the prevention,
diagnosis and treatment of disease.
We have gained tremendous knowledge through
research and the result is improving care for women. We now have
diagnostic tools, tests and treatments that better account for the
biological health differences between women and men.
For example, we have implanted defibrillators and
replacement joints that are size and shape appropriate. Previously, such
devices were often too large for women, because they were designed with
men in mind. Advances in diagnostic tests are also improving our ability
to detect and treat heart disease in women, which manifests itself
differently than it does in men.
We are concerned that the proposed changes to the
payment system could reduce womens access to the best and most
appropriate care, because many of the diagnostics, devices and
treatments designed for women are among the newest developments. Women
have been waiting a long time to receive the right information and the
right care in both hospitals and physicians offices. Now is not the time
to make it more difficult for women to get access to the health care
tools they need.
We are also concerned that the proposed changes to
the rule will have a chilling effect on research and development of
devices and diagnostics that are gender specific. If, through inadequate
coverage, the system makes it difficult for new technologies to be
utilized, innovation and future research will be stifled.
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