Month: February 2012

Main Category: Stroke
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 19 Feb 2012 – 0:00 PST

email to a friend   printer friendly   opinions  

<!– rate article

Patient / Public:

Healthcare Prof:

Stroke-related language impairment adds about $1,703 per patient to medical costs the first year after stroke, according to research reported in Stroke: Journal of the American Heart Association.

Researchers retrospectively examined the records of 3,200 South Carolina Medicare patients who had ischemic strokes in 2004 and found:

• Twelve percent (398 patients) had aphasia or language impairment.
• Medicare payments for those with aphasia averaged $20,734 per patient vs. $18,683 for those without it – an 8.5 percent increase.
• Aphasia patients were older and had more severe strokes.
• Aphasia patients stayed in healthcare facilities 6.5 percent longer and had higher rates of illness and death.

“These findings are important because dramatic changes are occurring in healthcare reimbursement, specifically imposed caps on Medicare reimbursement for outpatient speech language pathology and physical therapy,” said Charles Ellis Jr., Ph.D., lead author and associate professor of Health Sciences and Research at the Medical University of South Carolina in Charleston. “Although the current reimbursement cap is $1,870 for these therapies, the financial burden of the cap remains a major limiting factor to access long-term rehabilitation for patients with persisting aphasia.”

Annually, about 100,000 people who suffer a stroke will be left with language deficits due to aphasia.

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Medical Devices / Diagnostics
Article Date: 15 Feb 2012 – 1:00 PST

email to a friend   printer friendly   opinions  

<!– rate article

Patient / Public:

Healthcare Prof:

A new study by researchers at Tufts Medical Center provides unique insight into factors that affect Medicare decisions on whether to pay for medical technologies. The study, published online by the journal Medical Care, underscores that the Centers for Medicare and Medicaid Services has incorporated evidence-based medicine into its decision making, highlighting the importance of the strength and quality of the supporting clinical evidence. Further, the research provides important insight into the “reasonable and necessary” criteria, illustrating the significance of the availability of alternative therapies, while suggesting that CMS accounts for value in coverage decisions.

By law, Medicare is mandated only to cover medical technology deemed “reasonable and necessary” for the diagnosis of illness or injury in Medicare beneficiaries. CMS makes 10-15 national coverage determinations (NCDs) each year on technologies deemed to have a substantial impact on the program. Because CMS has not provided formal guidance on the interpretation of the “reasonable and necessary” criteria, it has not always been clear what factors play a role in technology coverage decisions. The new study is the first of its kind to evaluate quantitatively the factors underlying Medicare decisions.

The research also shows that CMS’s coverage of medical technology has become more restrictive over time. When controlling for other factors, CMS was ten times less likely to cover a technology from 2006 through 2007 than it was in the early 2000s.

“This research offers the medical community a better understanding of the type of evidence that Medicare considers in NCDs,” said lead author James D. Chambers of Tufts Medical Center, “thus providing a valuable insight into the reasonable and necessary criteria.” He added that “CMS and other payers can also benefit from this kind of external review of coverage decisions as it can help ensure the consistency of decisions and the integrity and accountability of the coverage process.”

The authors used data from the Tufts Medical Center NCD database, and conducted a logistic regression analysis to evaluate how various factors affect the likelihood of positive coverage.

Key findings include:

• CMS is favoring proven interventions. Compared to interventions with clinical evidence deemed “insufficient”, interventions with good or fair quality supporting evidence were approximately six times more likely to receive a positive decision.
• Interventions with available alternatives are less likely to be covered. Compared with interventions with no available alternative, those for which an alternative was available were approximately eight times less likely to receive a positive decision.
• CMS accounts for value in coverage decisions. Compared with technologies estimated to be dominant, i.e., more effective and less costly than the competing intervention considered, those with no published estimate of cost-effectiveness were approximately five times less likely to receive a positive coverage decision.
• Coverage decisions have become more restrictive over time. Compared with coverage decisions made in the years 1999 to 2001, decisions made from 2002 to 2003 were more than three times less likely to be positive. Decisions made from 2004 to 2005 were also more than three times less likely to be positive, and from 2006 to 2007 decisions were almost ten times less likely to be positive.

Privacy Policy |
Terms and Conditions

MediLexicon International Ltd
Bexhill-on-Sea, United Kingdom
MediLexicon International Ltd © 2004-2012 All rights reserved.