CMS recently announced a decision on Medicare
coverage of artificial hearts and a final rule on reimbursements for long-term
acute care hospitals. Summaries appear below.
- Artificial hearts: CMS last week announced
that Medicare will cover artificial hearts, as well as the implantation of
the devices, for beneficiaries who participate in studies approved by FDA, the Wall Street Journal
reports (Wall Street Journal, 5/5). The decision reverses a
policy established in 1986 that denied Medicare coverage for artificial
hearts, which are used in terminally ill heart failure patients. The
decision would apply to the AbioCor Total Replacement Heart, manufactured
by Abiomed, and the CardioWest temporary
Total Artificial Heart, manufactured by SynCardia Systems (Kaiser Daily Health Policy Report,
2/5). According to a CMS spokesperson, the decision would affect fewer
than 200 Medicare beneficiaries annually, with lifetime costs per
beneficiary expected to reach as high as $1 million. In a statement, CMS
officials said that the agency "believes there is now sufficient
scientific evidence on the use of artificial hearts to allow coverage of
these devices for beneficiaries in the carefully controlled clinical
environment of an FDA-approved study." Acting CMS Administrator Kerry
Weems said, "Our policy will allow beneficiaries to access artificial
heart technology while also stimulating the research community to develop
further evidence about the impact of this technology on improving patient
outcomes" (Reichard, CQ HealthBeat, 5/2).
- Long-term acute care hospitals: CMS on
Friday announced a final rule that will increase Medicare reimbursements
by 2.7% for long-term acute care hospitals for a 15-month period that
begins on July 1, CQ HealthBeat reports. Under the rule, such
hospitals will receive a total of $4.47 billion in Medicare
reimbursements, an increase of about $110 million compared with payment
levels for the current rate year. The rule will provide standard
reimbursements of $39,114, with additional payments to cover a percentage
of excess costs related to the treatment of more expensive patients (CQ
HealthBeat, 5/2).
Reprinted
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