CMS Proposes Reduced Medicare Rates for Heart Defibrillators

A proposed rule from the Centers for Medicare and Medicaid Services (formerly known as HCFA) would reduce the Medicare reimbursement rate that hospitals receive for implanting cardiac defibrillators -- the "device implanted in Vice President Dick Cheney's chest last weekend to control rapid heartbeats," the Baltimore Sun reports. CMS officials have concluded that hospitals have been receiving reimbursements for the procedure -- used to treat potentially dangerous irregular heartbeats -- that are comparable to payments for some open-heart surgeries, which are more expensive and "typically require longer hospital stays." An unnamed CMS source "insisted that under the new rule, hospitals would receive fair compensation for defibrillator implants and that doctors would be under no pressure to avoid offering them to patients." . . . . offering them to patients" (Greene, Baltimore Sun, 7/4). A CMS source added that the defibrillator procedure is now less complicated than in the past and typically requires shorter hospital stays (CMS press office, 7/5). While there are slightly different reimbursement rates for different variations of the procedure, reimbursement could drop in general by 7% to 8% (Goldstein, Washington Post, 7/4). The new payment rates, released in May for 2002, are not yet final and are subject to change as the government considers comments from the public (CMS press office, 7/5).

A 'Major Concern'
Many cardiologists who specialize in the defibrillator procedure are "not pleased" with the proposal, and have used Cheney's recent surgery to publicize their disagreement with the rate reduction (Washington Post, 7/4). Dr. Eric Prystowsky, president of the 3,500-member North American Society of Pacing and Electrophysiology, said that a reimbursement reduction could lead smaller hospitals not to offer the procedure because the rate would not cover all hospital costs. These doctors are also concerned that patients might have difficulty obtaining a procedure that "thousands of Americans might need" but are unaware of. "It's a major concern," Dr. Susan O'Donoghue, the associate director of the Cardiac Arrhythmia Center at Washington Hospital Center and a specialist in irregular heart rhythms, said, adding, "We would have to ask the hospital to be prepared to lose money on every patient we implant defibrillators in. And we would expect it would be harder to provide these things for patients." Despite Cheney's "high-profile" surgery, a lower rate would not have affected his treatment since he is too young to qualify for Medicare and is privately insured. In addition, the Sun notes that Cheney underwent the procedure on an outpatient basis, but the proposed rule would only affect inpatient visits (Baltimore Sun, 7/4).

Two Opinionmakers
Noting that Cheney is among the 5% to 10% of Americans receiving defibrillators implants who undergo the procedure for preventive reasons, and that he did so only days after his problem was identified, David Cannom, writing in the Los Angeles Times, asks, "Where was the primary care physician in the decision-making process, unless it was the widely quoted chief of medicine at George Washington University Hospital? Was there a managed care official involved, or was President Bush standing in for the HMO when he said that he thought the procedure was a good idea?" Cannom, medical director of cardiology at Los Angeles-based Good Samaritan Hospital, states that most managed care patients in California would have had go through a "procedure approval system that is slow, arbitrary and designed to postpone or prevent care." Cannom said he is hopeful that Cheney's surgery will make more primary care doctors "aware of the important role" of defibrillator implants for "high-risk patients like Cheney" and will make it "more difficult for insurance plans to turn down treatment requests for similar patients," thus making the "'Cheney standard' ... generally accepted for all patients" (Cannom, Los Angeles Times, 7/5). A Detroit Free Press editorial states that "[e]very Tom, Dick and Harry should have the same level of medical care Vice President Dick Cheney enjoys." The "real lesson" from Cheney's "cardiac episodes," according to the editorial, is that "regular, preventive medicine is crucial." Noting that 44 million Americans are uninsured, the editorial concludes: "May Cheney's defibrillator help him lead a long and healthy life. May it also open his heart -- and the Bush administration's eyes -- to the need to give all Americans a shot at staying healthy" (Detroit Free Press, 7/5).