Medicare To Weigh Cost As A Factor In Reimbursement
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In a fundamental shift, the Federal Government will explicitly weigh cost as a factor in deciding whether Medicare should pay for new medical procedures, devices and drugs for elderly people. A confidential draft of new Medicare rules, now awaiting a final clearance that is usually a formality, says an “explosion of high-cost medical technologies” has made it necessary to consider cost in deciding whether to expand, continue or terminate coverage of specific services. Medicare decisions about the coverage of new items and procedures have an impact far beyond the Federal program, because private health insurers often follow the Government’s lead in deciding whether to pay for goods and services. ‘Justify the Additional Cost’ Since the inception of Medicare 25 years ago, Federal officials have decided whether to cover new services and procedures, like liver transplants and magnetic resonance imaging, on the basis of their safety and effectiveness. Now the Government intends to consider another factor: whether an item or procedure costs more or less than the alternatives already approved for use by the 34 million elderly and disabled people enrolled in Medicare. More : query.nytimes.com |