Kaiser Daily Health Policy Report Highlights Recent Medicare Development
Heart scans: The American College of Cardiology and the National Electrical Manufacturers Association on Wednesday praised a decision by CMS not to move forward with a proposal that would have limited coverage of certain cardiac scanning technology, CQ HealthBeat reports. The proposal would have limited use of "computed tomographic angiography," which uses CT scans to diagnose coronary artery disease, to use in clinical trials. Proponents of the technology say that it can replace coronary angiography in some patients, which is a more invasive procedure. However, CMS in a summary of its decision on Wednesday said that there is uncertainty about the health benefits of the test's use to diagnose heart disease in patients with chest pain and that there is limited medical evidence that the test improves "health outcomes" (Reichard, CQ HealthBeat, 3/13).
Oxygen: CMS is expected to announce new payment rates for oxygen equipment and nine other classes of durable medical equipment under a competitive bidding pilot program in 10 metropolitan areas, The Hill reports. The new rates "will hit the industry at the same time it is waging another fight against legislation that would place additional limits on the oxygen benefit" in Medicare, according to The Hill. The Hill reports, "The combined effect of this anxiety and the actual lost dollars from industry-wide payment reductions taking effect this year is taking its toll on the oxygen suppliers." Chris Kane, chief operating officer for Pacific Pulmonary Services, said bids from companies that are lower than current payment rates do not necessarily prove that Medicare is overpaying for durable medical equipment. He said, "What's missing from competitive bidding is a clearly defined service component," adding that companies that offer fewer ancillary services to patients could submit lower bids and drive out companies with higher bids that provide higher-quality service (Young, The Hill, 3/13).
Sleep apnea: CMS on Thursday announced that it is expanding reimbursement for devices that help relieve obstructive sleep apnea to beneficiaries who are diagnosed through less-costly take-home tests, Dow Jones reports. The continuous positive airway pressure systems for sleep apnea include air blowers and face masks that assist in keeping airways open while people sleep. Previously, Medicare only covered the devices for beneficiaries diagnosed at sleep laboratories, where testing can cost between $1,000 and $1,200. Matthew Borer -- director of investor relations at ResMed, a maker of such devices -- said that currently about 20% of patients in the U.S. with sleep apnea who use the machines are Medicare beneficiaries. CMS said it would limit initial coverage of the devices to 12 weeks to determine whether beneficiaries are responding to the treatment. The agency will continue covering the treatment if beneficiaries show improvement (Kamp, Dow Jones, 3/13). Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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