Panel to Decide Fate of Medicare Body Scan Proposal
The Medicare Coverage Advisory Committee, formed last year to advise Medicare about the merits of potential new services, will consider a "controversial" proposal to add an expensive, high-tech body scan to the program's list of covered benefits, the Washington Post reports. Similar to an MRI, the proposed scan, called positron emission tomography, detects a wide range of illnesses, including the most common forms of cancer. If approved, the move would represent a "significant expansion" of Medicare and could "set a precedent" for how the program defines "reasonable and necessary" medical procedures. While advocates argue that the PET scan could more accurately and quickly diagnose illnesses, opponents contend that Medicare should only approve the procedure on a "disease-by- disease" basis. PET scans have a price tag of about $2,000 to $3,000, and providing the test under Medicare would likely cost taxpayers "billions of dollars." Using its guidelines for evaluating diagnostic technologies for the first time, the Medicare advisory panel, comprised primarily of physicians from academic institutions, will meet today in Baltimore to decide whether to recommend that Medicare cover PET scans before HCFA issues a final ruling by Dec. 15. The politically charged issue "underlies a revolt of physicians against managed care" and efforts by the government and private insurers to control health care costs. In addition, the committee's decision will have a "huge bearing" on Medicare's future handling of new medical procedures and "indirectly affect" private insurers' coverage decisions. "I think people will pay a lot of attention to it. Given the various ways of evaluating a technology, if (Medicare) uses one, it will attract attention and others will be more likely to use it," one government official said. While Blue Cross and Blue Shield has given PET scans a "less than wholesale endorsement," NIH's National Cancer Institute backs Medicare coverage for the procedure. Sens. Ted Stevens (R-Alaska) and Bill Frist (R- Tenn.), who sponsored legislation several years ago to provide PET coverage under Medicare, have also served as "big advocates" of wider use of the procedure. The Post reports that Stevens is a close friend of Michael Phelps, the UCLA chemist who "invented the technology in the early 1970s," and that a "worldwide supplier of PET scanners," CTI, Inc., is headquartered in Knoxville, Tennessee -- Frist's home state (Brown, Washington Post, 11/7).This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.