Medicare Policy Change Will Significantly Reduce Treatment Options for Cancer Patients and Others with Lymphedema

  • Alan T Hirsch

Press / Media: Public Engagement Activities

Description

http://www.prnewswire.com/news-releases/medicare-policy-change-will-significantly-reduce-treatment-options-for-cancer-patients-and-others-with-lymphedema-300175536.html

-------------------------------------------------------------------------------------------------------

MINNEAPOLIS, Nov. 10, 2015 /PRNewswire/ -- Despite convincing clinical evidence on the health and economic benefits of home therapy, Medicare has proposed a policy that will severely restrict reimbursement for pneumatic compression devices (PCDs) for over one million lymphedema patients who could benefit from such treatment. The proposed change in policy was published without sound scientific justification and without adequate consultation with either health professionals or patients.

Lymphedema, which presents as swelling of the limbs and other parts of the body, is a lifelong, progressive and often debilitating condition that results from damage to, or impairment of, the lymphatic system. If this change in reimbursement goes through, many patients will be left without access to treatment to address disabling symptoms that are not responding to other therapeutic options.

Medicare has covered pneumatic compression devices for lymphedema home treatment for over 20 years, and has long maintained a position that these devices are an effective at-home treatment option. The proposed change in policy means, however, that they will no longer reimburse most patients for their use.

Lymphedema affects over five million people in the United States. It is caused by cancer intervention (surgical scarring, lymph node removal or radiation), poor circulation (venous insufficiency), trauma and obesity. Over one million Medicare patients with lymphedema could lose access to coverage for PCDs.

"I care about how this nation serves each patient and how we use clinical evidence to protect the national health budget," said Alan T. Hirsch, M.D., Director of the Vascular Medicine, Quality Outcomes and Population Health Program at the University of Minnesota Medical School and Chief Medical Officer of Tactile Medical. This relationship is managed by the University of Minnesota in accordance with its conflict of interest policies. "Responsible health professionals seek to support policies that improve both individual and community health. I cannot imagine how this proposed Medicare policy achieves either aim. By depriving patients with lymphedema access to a proven, effective therapeutic option, these individuals and their families will likely suffer. The opportunity to improve health and functional independence as well as to lower national healthcare costs would be lost."

Clinical evidence has shown that patients have a tremendous need for effective ongoing treatment to improve the edema and slow the progression of symptoms. The goal of lymphedema treatment is to prevent the condition from progressing to a severe level, characterized by skin breakdown, risk of serious infections, large and disfiguring lobular deformations and often loss of mobility. If enacted, the proposed policy change would delay or prohibit access to treatment until patients reach the most severe - and perhaps irreversible - stage of symptoms.

Access to effective clinical care has never been easy for patients with lymphedema. Action must be taken immediately or Medicare will enact this restrictive new policy on December 1, 2015. Physicians, patients and advocates are being urged to visit www.PCDpolicy.org to learn more. The website will assist with contacting legislators to ask that the new Medicare policy for Pneumatic Compression Devices be withdrawn. Reference: FUTURE Local Coverage Determination (LCD): Pneumatic Compression Devices - Released by Durable Medical Equipment Medicare Contractors on 10/15/2015 to become effective 12/1/2015. 

Opinions on this proposed policy, and the negative impact it will have, can also be shared on social channels via the hashtag #PCDpolicy. 

Please visit www.PCDpolicy.org for additional information on how you can help.

PeriodNov 1 2015

Media coverage

1

Media coverage

  • TitleThe Cutaneous, Net Clinical, and Health Economic Benefits of Advanced Pneumatic Compression Devices in Patients With Lymphedema
    Date11/1/15
    Producer / AuthorPinar Karaca-Mandic, PhD; Alan T. Hirsch, MD; Stanley G. Rockson, MD; Sheila H. Ridner, PhD, RN
    URLarchderm.jamanetwork.com/article.aspx?articleid=2453326
    PersonsAlan T Hirsch