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Medicare to Pay for Major Lung Operation
By
DENISE GRADY
Medicare will begin paying for a major lung operation for certain people 65 and over who have severe emphysema with specific traits that make them likely to benefit from the surgery, the government announced yesterday. The operation, lung volume reduction surgery, involves cutting away diseased parts of the lungs to help the remaining healthy tissue work better. As much as 30 percent of the lungs may be removed. The operation costs about $60,000. Private insurers and state Medicaid programs generally follow Medicare's example. Medicare said yesterday that it would cover the operation for two groups of patients: those who have severe emphysema in the upper lobes of their lungs, and those who have both severe disease elsewhere in the lungs and a poor ability to exercise. In addition, such patients would need certain other test results to make sure they were not at high risk of dying from the surgery itself. Medicare will also require that patients be given an extensive exercise and education program to improve lung function both before and after the surgery. The operation will be covered only at certain hospitals accredited by the Centers for Medicare and Medicaid Services; the hospitals have not yet been named. Two million Americans have emphysema, but only a small fraction — perhaps as few as 10,000, researchers say — would qualify for the surgery. The disease, which destroys the air sacs in the lungs, makes it increasingly harder to breathe. It is nearly always caused by smoking. Emphysema is incurable and often fatal, and it causes or contributes to 100,000 deaths a year in the United States. Caring for people with the disease costs more than $2.5 billion a year. The decision to begin covering the lung reduction surgery is based on the findings of a government-sponsored study published in May in The New England Journal of Medicine. That study, called NETT, for National Emphysema Treatment Trial, found that in about 25 percent of participants, the operation improved both quality of life and length of survival. In others, it did not prolong life but did improve exercise capacity or overall quality of life. In an additional 30 percent, the operation was either too risky or simply did not help. Lung reduction surgery, developed in the last decade, quickly became popular even though, until recently, no large, rigorous studies had been done to find out whether it was safe or effective. Medicare initially paid for the surgery and then stopped, citing the lack of data. It then agreed to cover the procedure only in patients who enrolled in NETT, which started in 1996. Copyright
© 2002 Global Action on Aging
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