Date: February 1st, 2001
When throat cancer forced a Pennsylvania physics professor to have his larynx removed, he thought his lecturing days were over. But a marvelous device called the UltraVoice voice synthesizer has allowed him to speak clearly and remain fully employed.
In Brooklyn, New York, a breakthrough cardiovascular technology called intravascular radiation therapy is helping a woman resume her active life caring for two grandchildren. She had nearly given up hope after three angioplasties, two stents and open-heart surgery failed to keep her arteries open.
The good news is that advanced medical technology is saving and improving millions of lives, and has the potential to drastically reduce overall health care costs as well. The bad news is that the 39 million seniors and people with disabilities covered under the Medicare program are routinely denied access to these advances. The result: a system that threatens innovation and causes unnecessary human suffering.
FACT: Medicare can take 15 months to five years or more to make new medical technologies and procedures available to Medicare patients.
FACT: Medicare patients often cannot gain access to the advanced diagnostic tests they need because of serious delays in the agency's coding and payment procedures. Yet these breakthrough tests can detect diseases earlier, when they are more treatable. Early detection saves patients' lives and reduces overall treatment costs.
FACT: More than 50,000 people will be diagnosed with bladder cancer this year. A breakthrough bladder cancer test for at-home and physicians' office use won an award in 1999 as the most innovative medical product of the year. But because of Medicare payment delays, the manufacturer has stopped marketing it to physicians' offices.
FACT: The small private company that makes the UltraVoice voice synthesizer could go out of business. Medicare patients make up about 80 percent of its customers, yet Medicare significantly underpays for the device and has delayed correcting the problem for years.
Inadequate Medicare reimbursement and delays in updating payment levels have made it difficult or impossible for Medicare patients to receive many important therapies, including:
- cochlear implants, which can restore hearing in severely deaf individuals;
- a unique bone-healing device that helps people avoid surgery and amputation;
- implants to treat the symptoms of Parkinson's disease and epilepsy;
- the first non-invasive glucose monitor for adults with diabetes; and
- genomic testing for early detection of cancer and other diseases.
What's Been Done
In December 2000, Congress passed legislation that will help improve Medicare patients' access to advanced medical technology. Called the Medicare Benefits Improvement and Protection Act, it has the potential to speed up patient appeals and reduce delays in coverage, coding and payment. But the fact is, these provisions have yet to be implemented and nothing is fixed quite yet.
What Needs to Be Done
It is urgent that we keep pressure on government health agencies to implement the provisions fully and rapidly. And we must seek additional improvements. The Administration, Congress, medical technology companies and patients must all work together to support bipartisan legislation that promotes timely patient access and eliminates bottlenecks in the review of new medical technologies.
Thirty-five years ago, Medicare was established to ease the concerns of seniors. It is now one of their greatest sources of aggravation. It's time to restructure the program. We need a Medicare system that moves with the pace of medical innovation and allows for more senior choice.
The most important thing you can do is educate yourself and offer constructive and informed opinions to legislators and other health care policymakers. Relate your access troubles to Congressional representatives, but go one step further. Help them shape the policies that will affect you, your parents and your children. Prepare for the coming revolution in medicine.