Hospital groups want Congress to force HCFA to speed up its review of a controversial surgical procedure that the agency says Medicare will no longer pay for.
In January, HCFA announced it was halting Medicare reimbursements for lung reduction surgery, a technique that supporters say makes it easier for emphysema patients to breathe.
Through a spokesman, the agency said it had discontinued payment for the procedure because the "long-term benefits in treating emphysema have not been established." But critics charged that HCFA was rationing care to save money.
Hospital groups want Congress to use the appropriations process to make HCFA decide by the end of fiscal 1997 whether it will pay for the surgery. The agency wants to wait until the end of a seven-year clinical trial.
In a recent interview, Joel Cooper, M.D., who invented the surgery, said HCFA needs to be careful to "distinguish between legitimate scientific inquiry and rationing."
HCFA's decision also provoked an outcry from hospitals that already were performing the procedure.
"There are a number of hospitals out there that have made a significant investment in facilities and staff, and for HCFA to say that they are not going to pay for this without any notice is outrageous," said Thomas Scully, president of the Federation of American Health Systems.
HCFA asked the Agency for Health Care Policy and Research to review the issue to determine whether it was medically sound. After a review of more than 3,000 cases, the AHCPR said the evidence was inconclusive.
A separate study by the American Thoracic Society concluded the procedure should only be performed at facilities where outcomes can be studied.
On the basis of those studies, HCFA recently announced it would pay for nearly 1,200 procedures as part of a seven-year clinical trial to be run by the National Heart, Lung and Blood Institute.
According to a NHLBI spokeswoman, the trial will take place at 10 to 15 hospitals around the country. Those hospitals will be selected by the end of 1996, and the first patients are scheduled to be enrolled by the summer of 1997.
But that timetable has supporters of the procedure crying foul. They say the study is so limited and will take so long that for most hospitals it will effectively bar the procedure.
Scully deemed appropriate concerns about the growth of the surgery, particularly at hospitals that are not equipped to perform the surgery. However, the answer, he said, is not to drastically reduce the number of procedures but to set-up centers of excellence at facilities equipped to handle a large volume.
According to the FAHS, about 4,000 lung reduction procedures were performed last year, up from about 200 in 1992. The surgery cost between $25,000 and $70,000 depending on the level of acuity.
According to the Congressional Budget Office, allowing payment for the surgery would cost Medicare about $110 million annually.