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Opinion: Medicare
Drum
Beat to Reduce Medicare Costs May Endanger Some Senior Citizens
Study says switching some from ICDs to AEDs could save money
to help more
seniors but it may also be way to just save money
By
Tucker Sutherland, editor
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"
it might be reasonable for Medicare to provide the less expensive
defibrillator to many more Medicare beneficiaries." - Peter Cram, M.D. |
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June
19, 2006 The growth of Medicare costs is undoubtedly the largest
financial challenge facing the U.S. and a research team suggests the
program can save millions by making tougher judgments on which senior
citizens get implantable cardioverter defibrillators (ICDs), and which
must settle for the less expensive, less reliable automated external
defibrillators (AEDs). The thrust of the study, however, is not on
reducing Medicare's cost, but on freeing up money to provide help to
more seniors.
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To
put this study in it best light, the news release says, "Medicare
beneficiaries with heart failure could benefit from new strategies to
decide who qualifies for lifesaving implantable cardioverter
defibrillators (ICDs), according to a University of Iowa study."
The
commendable approach the researchers take is that shifting some seniors
to the cheaper AEDs will free up Medicare money to provide more
defibrillators for more
seniors who need them.
But,
clearly there is a strong underlying message probably unintended,
since they do not suggest Medicare reduce spending -
that this strategy can also be used to serve the same number of seniors
and save substantial money. All Medicare has to do is stiffen the
requirements of ICDs and give the non-qualifiers AEDs.
"ICDs
are very expensive and very effective. AEDs are less expensive but not
nearly as effective. But for the same total expenditure, it might be
reasonable for Medicare to provide the less expensive defibrillator to
many more Medicare beneficiaries," said Peter Cram, M.D., the study's
lead author and assistant professor of internal medicine in the UI Roy
J. and Lucille A. Carver College of Medicine.
"Medicare is facing a budget crunch. The U.S. population is aging.
Budgets are tight. Medicare needs to be innovative and think carefully
about how to maximize the value it provides to American seniors," Cram
added.
The
U.S. Medicare Program spends about $4.6 billion dollars each year
providing ICDs to older Americans. The investigation, published in the
June 16 online early issue of the journal Value in Health, explored what
would happen if Medicare spent the same amount of money to provide more
patients with less expensive, yet also less effective, automated
external defibrillators (AEDs).
An
ICD is a small, pager-sized device implanted beneath the skin that uses
electric shock to restore normal heart rhythm and costs about $40,000.
An AED is a briefcase-sized device that requires a bystander to use pads
that deliver an electric shock to restore the victim's heart rhythm and
costs about $2,000.
The
research team chose to focus on ICDs because they are both expensive and
in high demand for patients enrolled in Medicare. The devices are
commonly given to patients whose heart is pumping at less than 30
percent of capacity.
The
nearly $4.6 billion Medicare spends annually on implantable
defibrillators benefits approximately 40,000 patients. However, the
investigators suggested that if Medicare shifted some of this money from
purchasing ICDs to purchasing the less expensive AEDs, then thousands of
additional patients might benefit.
The
study used computer simulations to analyze three scenarios involving
hypothetical Medicare patients: patients receiving ICDs, patients
receiving AEDS for in-home use, and patients relying on emergency rescue
services.
An
ICD costs on average $40,000, including implantation. With checkups and
device upkeep, the average cost rises to about $115,000 per patient. An
AED costs about $2,000, so with accompanying care, the AED cost is about
$5,500 for each patient, the study says.
"Medicare could potentially assign patients to get either an ICD or AED
based upon the patient's level of risk for heart problems," Cram said.
"This would ensure that the maximum number of patients benefit while
preserving the Medicare budget."
Cram
noted the study has several limitations, including the assumption that
AEDs would be given only to patients who live with others capable of
administering the device.
Possibly Dr. Cram and his associates have a good
idea that will help more senior citizens live longer, healthier lives.
This is certainly a goal we applaud. Our concern is that such studies be
used to put a price tag on the value of an older person's life and the
government begins to trim the Medicare budget by assigning seniors to
less expensive but more risky treatments.
But, maybe that is inevitable, if healthcare costs
continue to shoot upward.
Seniors can expect studies
at least suggesting ways that Medicare benefits can be trimmed are managed with
greater emphasis on cost containment.
Notes on the study:
In
addition to Cram, the study team included David Katz, M.D., UI associate
professor of internal medicine and epidemiology, and investigators from
the Ann Arbor Veterans Affairs Health Services Research and Development
Field Program, the University of Michigan School of Medicine, University
of Michigan School of Public Health and the Institute for Clinical
Research and Health Policy Studies at Tufts-New England Medical Center
in Boston.
Cram is supported by a Career Development Award from the National Center
for Research Resources of the National Institutes of Health.
The
research article also will appear in volume 9, issue 5, of the print
issue of Value in Health, the official journal of the
International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Value in Health (ISSN 1098-3015) publishes papers, concepts and ideas
that advance the field of pharmacoeconomics and outcomes research and
help health care leaders to make decisions that are solidly
evidence-based. The journal is published bi-monthly and has a regular
readership of over 3,000 clinicians, decision-makers and researchers
worldwide.
ISPOR is a nonprofit, international organization that strives to
translate pharmacoeconomics and outcomes research into practice to
ensure that society allocates scarce health care resources wisely,
fairly and efficiently. For further information on ISPOR, visit
http://www.ispor.org.
University of Iowa Health Care describes the partnership between the UI
Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and
Clinics and the patient care, medical education and research programs
and services they provide. Visit UI Health Care online at
http://www.uihealthcare.com.
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