Researchers at Tufts Medical Center conducted a study to quantitatively evaluate the factors underlying Medicare decisions on medical technology, according to a news release.
CMS is mandated to cover medical technology deemed "reasonable and necessary," but little explanation of what qualifies as reasonable and necessary is available. The study attempted to uncover those factors.
Key findings include:
1. CMS favors proven interventions. Compared to interventions with clinical evidence deemed "insufficient," interventions with good or fair quality supporting evidence were approximately six times more likely to receive a positive decision.
2. Interventions with available alternatives are less likely to be covered. Compared with interventions with no available alternative, those for which an alternative was available were approximately eight times less likely to receive a positive decision.
3. CMS accounts for value in coverage decisions. Compared with technologies estimated to be dominant, i.e., more effective and less costly than the competing intervention considered, those with no published estimate of cost-effectiveness were approximately five times less likely to receive a positive coverage decision.
4. Coverage decisions have become more restrictive over time. Compared with coverage decisions made in the years 1999-2001, decisions made from 2002-2003 and 2004-2005 were more than three times less likely to be positive. From 2006-2007 decisions were almost ten times less likely to be positive.
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CMS is mandated to cover medical technology deemed "reasonable and necessary," but little explanation of what qualifies as reasonable and necessary is available. The study attempted to uncover those factors.
Key findings include:
1. CMS favors proven interventions. Compared to interventions with clinical evidence deemed "insufficient," interventions with good or fair quality supporting evidence were approximately six times more likely to receive a positive decision.
2. Interventions with available alternatives are less likely to be covered. Compared with interventions with no available alternative, those for which an alternative was available were approximately eight times less likely to receive a positive decision.
3. CMS accounts for value in coverage decisions. Compared with technologies estimated to be dominant, i.e., more effective and less costly than the competing intervention considered, those with no published estimate of cost-effectiveness were approximately five times less likely to receive a positive coverage decision.
4. Coverage decisions have become more restrictive over time. Compared with coverage decisions made in the years 1999-2001, decisions made from 2002-2003 and 2004-2005 were more than three times less likely to be positive. From 2006-2007 decisions were almost ten times less likely to be positive.
Related Articles on Medical Technology:
5 Tips for Managing Implants Profitably
Medical Equipment Company Mergers and Acquisitions down 8% in Q4 2011
Survey: Medical Device Companies Plan to Raise Prices to Offset Tax