Paul Ginsburg, PhD, commissioner and senior fellow in economic studies at the Brookings Institution, Washington, suggested that, for any new procedure or drug, initial coverage is always provisional for a certain length of time, which would force CMS to revisit coverage decisions.
“If there is no evidence, the coverage ends,” Dr Ginsburg said. “If there is positive evidence, the coverage proceeds.”
However, as commissioner Rita Redberg, MD, of the University of California, San Francisco, said of CMS, even with tools to cut coverage, its hands may be tied by outside forces. “CMS needs a lot more political cover.”
Gregory Twachtman/MDedge News
Dr. Rita Redberg
She recalled a December 2007 CMS proposal to cut back reimbursement for cardiac CT scans to symptomatic patients and to only within the context of an approved clinical trial. Three months later, the agency withdrew the proposed national coverage decision and left it to local carriers to determine whether the procedure would be covered.
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