Medicare must act fast to ensure continued patient access
to innovative outpatient treatments
Television and newspaper reports across the country this week highlighted new problems that Medicare patients could face in gaining access to advanced treatments in the hospital outpatient setting. Medicare announced in an Aug. 20 proposed rule that it could make potentially deep cuts in outpatient payment for new technologies. This "could mean that millions of Medicare patients might stay in the hospital [overnight] unnecessarily," the Los Angeles Times reported. The Centers for Medicare and Medicaid Services, which runs Medicare, must work quickly to fix problems in its outpatient payment program and avoid deep cuts that would threaten patient access.
Medicare Proposal Will Reverse Gains in Delivery of High-Quality, Cost-Effective Outpatient Care
· - Over the past decade, advances in medical technology have transformed health care and enabled more and more patients to receive innovative tests and treatments in the more convenient, less costly outpatient setting.
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- In fact, the number of hospital outpatient visits rose to 84.6 million in 1999, an increase of 49 percent since 1992, according to the National Center for Health Statistics.
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- As a result, fewer patients must stay overnight at the hospital for inpatient visits, which are far more costly. CMS' own data show that the number of inpatient hospital beds per thousand patients has dropped from 46.7 in 1980 to 26.3 in 1998.
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- The potential deep reimbursement cuts announced by CMS would reverse this trend.
CMS must act quickly to preserve Medicare patients' access to innovative outpatient treatments.
· - CMS says in the proposed rule that it will examine alternative approaches to avoid making deep cuts in outpatient payments for new technology to treat a wide range of conditions such as coronary artery disease, heart rhythm disorders, cancer, diabetes, arthritis and cataracts. However, it offers scant information on the specific steps it will take.
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- CMS must act soon to describe publicly and implement fully the changes needed to avoid deep outpatient payment cuts and ensure that Medicare's 40 million patients can continue to receive advanced medical treatments in this cost-effective setting.
VIEW A SAMPLE LETTER TO YOUR SENATOR OR REPRESENTATIVE BELOW:
To Senators:
The Honorable (full name)_____________
United States Senate
Washington, DC 20510
To Representatives:
The Honorable (full name)____________
United States House of Representatives
Washington, DC 20515
Dear Senator/Representative (last name):
I am writing to express my concern over the potential for significant payment cuts in “pass-through” payments for new technologies used in the hospital outpatient setting, which were announced by the Centers for Medicare and Medicaid Services on August 20.
I am deeply concerned that if these cuts are implemented, many Medicare patients will have to stay at the hospital overnight as an inpatient – and pay higher out of pocket deductibles – in order to receive these newer treatments. These cuts would affect a wide range of patients with diseases and conditions such as cancer, heart disease, diabetes and arthritis.
I urge you to work closely with CMS to stop any pass-through payment cuts and pursue alternative approaches. CMS should announce quickly the steps it plans to take to avoid payment cuts and preserve patient access.
Thank you for your commitment to quality, advanced medical care for America’s seniors and people with disabilities, and for taking the time to hear my concerns.
Sincerely,
The Los Angeles Times reported recently that the Department for Health and Human Services is considering making substantial cuts in Medicare reimbursement for high-tech drugs, devices, and biologics in the hospital outpatient setting – a move which some medical experts warn could force patients into the more costly, inconvenient inpatient setting.