Medicares role is hurting reimbursement for both bare-metal and drug-eluting stents. Under DRG payment rules adopted earlier this year, Medicare reimburses hospitals less for performing bare-metal stent procedures, Goodroe noted. Hospitals are also paid less when low-risk patients receive drug-eluting stents, or DES, than when higher-risk patientssuch as those who previously experienced a heart attackreceive them.
But with new studies showing that if you have some of these complications, you may not do well with a DES implant; surgeons are moving many patients into the bare-metal category, Goodroe said. Its the right thing to do, but that procedure pays hospitals less.
Even after factoring in the cost savings hospitals experience when purchasing bare-metal instead of drug-eluting stents, Goodroe estimated hospitals are experiencing a 20% loss of income in stenting procedures compared with a year ago.
There also are anecdotal data supporting the stenting revenue-loss theory. A report from the market research company Freedonia Group estimates, for example, that the demand for drug-eluting stents will decline by $750 million between 2006 and 2011. The report suggested no corresponding increase in the demand for bare-metal stents, however.
In addition, Boston Scientific and Johnson & Johnson both said in written statements issued last week that drug-eluting stent sales have fallen. Boston Scientific said U.S. sales of drug-eluting coronary stent systems for the third quarter of 2007 fell to $240 million compared with
$384 million for the same period in 2006. Johnson & Johnson, meanwhile, said its revenue growth was hurt by fewer sales of drug-eluting stents sold under its Cordis brand.
But Nicholas Sears, chief medical officer with group purchasing organization MedAssets, said a drop in stenting revenue doesnt necessarily indicate a drop in revenue for hospitals. In fact, he suggests that hospitals are seeing an increase in other cardiovascular procedures as a result of studies indicating higher risks associated with DES implants.
Goodroe acknowledged most of the stenting-revenue data dont paint a clear picture, and said hospitals will have to wait for a definitive analysis to know if their experiences reflect a nationwide trend.