TCS Daily

Cutting Medicare's High-Tech Outpatient Care Hurts Seniors And Wastes Money

By David Charles - September 19, 2001 12:00 AM

In the wake of the acts of war perpetrated by terrorists the debate in Washington over spending priorities has been rightfully muted. Yet many Americans are worried about how America will fund two key programs that touch millions of lives: Social Security and Medicare.

In the wake of the acts of war perpetrated by terrorists the debate in Washington over spending priorities has been rightfully muted. However, as a physician, I can't keep silent as I watch Medicare getting ready to eliminate payments for new healthcare technology, which is not only life saving, but ironically cost saving as well.

The Centers for Medicare and Medicaid Services (CMS), which administer Medicare, are dangerously close to approving drastic reductions in new, technologically advanced outpatient services. If these services are effectively eliminated by funding cuts, thousands of patients who could be treated as outpatients will have to be hospitalized, resulting in much higher costs for their care and greater disruption of their lives.

In recent years, the cost of medical technology has become a popular target for HMOs and others with an interest in cutting back on allowable health care benefits. In medicine, as in any business, fundamental advances in technology are initially expensive. As they become widely used, though, they tend to pay for themselves through greater efficiency and improved results.

The new outpatient technologies approved for Medicare just a few years ago are definitely advanced. For instance, Activa Therapy (Deep Brain Stimulation) is used to alleviate tremor and other cardinal symptoms of Parkinson's disease. The system targets cells in the brain via a lead or leads that are surgically implanted in the brain. One or more leads as required are connected to neurostimulators implanted near the collarbone. The mild electrical stimulation can be adjusted non-invasively to meet each patient's needs.

ITB Therapy is used to treat the severe spasms associated with multiple sclerosis, spinal cord injury, cerebral palsy, brain injury and stroke. An infusion pump is surgically implanted in the abdomen and connected to a small, flexible catheter that delivers tiny amount of medication directly where it's needed, the spinal fluid. This helps minimize side effects that often accompany oral medications.

Many of today's most effective outpatient services are the result of advances in the science of telemedicine, which has made them both more available and more affordable than they would have been even five years ago.

In another painful irony for taxpayers and Medicare patients, these new treatments are now under siege largely because of a simple accounting error by CMS. The CMS accounting system has distorted the real costs of the advanced services by adding in costs that are part of fundamental outpatient services -- costs that Medicare would have paid even if the advanced services did not exist.

We should all be thankful, however, that these advanced outpatient services do exist. Keeping them available to the 39 million Americans enrolled in Medicare will improve the quality of life for many of them. Over the long term it will also ease the financial burden on the Medicare system.

Ninety members of Congress have recognized this and are objecting to these and other proposed reductions. Physicians and patients' groups have joined them. As a practicing physician who has seen the effectiveness of this technology first-hand, I'm acutely aware of the price patients would pay if Medicare eliminates these outpatient services in the name of false economy.

Dr. Charles is the Director of the Movement Disorders Clinic at Vanderbilt University Medical Center and Chairman of the National Alliance of Medical Researchers and Teaching Physicians.


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