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New Bill Could Help Modernize Medicare

By THE ASSOCIATED PRESS

NY Times, February 26, 2003

 

 

WASHINGTON (AP) -- Chicago spinal surgeon Stephen Ondra tries to keep his elderly patients mobile, but he says outdated Medicare rules are preventing him from getting new technology for them.

Some lawmakers want to address the problem with legislation to reduce the time it takes to get new technologies covered by Medicare.

``We have a population that's living longer and aging and still wants to be active,'' Ondra said. ``These are healthy people that would lead active lives for a long time, so there's a big return on the investment.''

Unfortunately, Ondra said, ``We're losing so much money on Medicare patients we can't deliver that care.''

Reps. Anna Eshoo, D-Calif., and Jim Ramstad, R-Minn., hope the bill they are introducing Wednesday will modernize the 38-year-old program to keep pace with changing health technology.

The legislation would make a number of regulatory changes to speed new medical treatments to patients, including six- to 12-month deadlines for Medicare to implement coverage and payment for new technologies. It would also create a Council for Technology and Innovation to improve coordination of coverage and payment decisions for new technologies.

Medicare would also be directed to provide reimbursement for routine costs of care incurred by the elderly while participating in clinical trials that involve breakthrough technologies like artificial hearts or bionic eyes.

The bill also would order the Medicare agency to develop a better system for appeals of claims denials. Currently Medicare patients appealing claims decisions wait months -- sometimes longer than a year -- to have an appeal heard.

Eshoo said the legislation would ``make things happen'' in the area of innovative treatments. She cited the reimbursements for elderly patients participating in clinical trials as key.

``It's very difficult to do testing on the elderly. It's a different kind of population. The risks can run higher and when the reimbursement is not there it gets to be kind of hands-off,'' Eshoo said. ``This bill would change all of that.''

Ondra said improved coverage of the new technologies would make a difference in his medical practice.

For instance, he has been unable to get Medicare to pay for the infusion bone graft device, which was approved by the Food and Drug Administration last year for certain back pain sufferers. The device contains a genetically engineered protein that eliminates the need from a hip graft, where bone is culled from a patient's hip to use in spinal surgery.

The newer technology, which costs about $3,000 a dose, ``will give us the same result without the morbidity to the patient,'' Ondra said, adding that there is less discomfort and potential for infection.

``Are we going to create second-class citizens in the Medicare population?'' Ondra asked. The legislation, he said, will ``help maintain their access to care.''

 


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