PET is an example of a major advance in medical technology, an outgrowth of federally supported medical research, that has been kept from our patients far too long due to disorganized and indifferent federal agencies such as HCFA, Shreve said. Over the last decade PET has become an indispensable tool in detecting many deadly diseases including multiple forms of cancer and Alzheimer s disease. However, it remains unavailable to Medicare patients for many key diseases because of delays and inefficiencies in Medicare s coverage process. One of America s leading cardiologists, Jeffrey Popma, MD, from Brigham and Women s Hospital in Boston, said that Medicare patients have faced similar barriers in gaining access to a breakthrough treatment for blocked coronary arteries intravascular radiation. The time lag has been entirely too long between FDA approval and availability under Medicare.
Patients are in fact being denied care.
Coronary radiation therapy is performed by temporarily inserting radiation-emitting seeds into an artery through a minimally invasive catheter. The radiation affects the blood vessel's cells in a way that helps prevent reclosure of the artery after angioplasty. However, problems with Medicare reimbursement threaten to create a major access barrier for the 50,000 beneficiaries each year who could benefit from this treatment. Due to delays in Medicare procedures, hospitals are significantly under-reimbursed for intravascular radiation. HCFA will take at least two years to set an appropriate reimbursement level.