Physician groups and medical device manufacturers are urging the federal government to allow Medicare to cover more experimental devices and technologies.
Testimony last week in Washington before the Practicing Physicians Advisory Council, a 15-member panel that advises HCFA on Medicare coverage issues, focused on confusion among providers and devicemakers over what devices and procedures Medicare will finance.
Medicare generally does not pay providers for devices that the Food and Drug Administration has approved under strict control for "investigational" uses.
Physicians and devicemakers said HHS added to the confusion with its probe this summer into whether hospitals billed Medicare and Medicaid for non-FDA-approved devices.
Virtually all the healthcare reform bills on Capitol Hill have included coverage of patient-care costs related to investigational devices under Medicare or a standard benefit package. The bipartisan mainstream group bill in the Senate covers such costs under the standard benefit package.
Physicians and device manufacturer representatives testifying before the council said the reimbursement policy needs to make clear whether Medicare will cover procedures related to the use of an investigational device. In many cases, such a device is an "incremental" improvement of an older model.
"Often, the new device is used in place of an older alternative and is sold at a price that does not exceed the amount currently charged for the older device," said G. Thomas Long, vice president of payment and policy with the Health Industry Manufacturers Association. "In many cases, the new device may result in shorter length of stay and other benefits which actually will reduce costs."
