Decision On Medicare Coverage Of Artificial Hearts

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CMS recently announced a decision on Medicarecoverage of artificial hearts and a final rule on reimbursements for long-termacute 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).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.

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