By John Morgan, Spotlight Health
With medical adviser Stephen A. Shoop, M.D.

Sen. Bob Dole has served our nation with distinction for over six decades as a patriot and statesman and been honored with the Presidential Medal of Freedom. Now he's fighting to free parents and grandparents from the bureaucracy of Medicare so they can receive the best healthcare possible.

"I'm here on behalf of more than 40 million Americans who deserve better opportunities to preserve their health," Doles says. "I'm talking about our citizens on Medicare who need improved access to breakthrough technologies and devices."

According to a recent healthcare policy report, approvals of new medical technologies and procedures for Medicare beneficiaries are routinely delayed 15 months to five years or more. 

This means that millions of Medicare patients cannot get the latest, often best healthcare treatments for their conditions.

"I have an innovative medical device in my body right now - just below my heart - that keeps the same condition that killed my father from suddenly killing me," Dole says. "It's called an endograft.  It's used to repair an abdominal aortic aneurysm.   I'm fortunate that I could afford this device.  It saved me from major invasive surgery, significant physical distress and a lengthy recovery process that would have burdened not only me but also my family."     

"There are an estimated 2.7 million Americans - most of them over 60 - who are walking around with the same time bomb in their bodies that I had," Doles adds. "But if they're on Medicare, they're not covered for new devices like mine.  They have to go the old school route which keeps them in the hospital longer and out of action for months."

Bill of rights

So Dole is calling for action.

He's helping launch a new bipartisan bill called the Medicare Innovation Responsiveness Act of 2003 (MIRA), authored by Rep. Jim Ramstad (R-MN) and Rep. Anna Eshoo (D-CA). Some of the bill's provisions would require Medicare to do the following:

• Establish a Council for Technology and Innovation to improve the timeliness and coordination of coverage, coding and payment decisions.
• Execute a 2000 policy to cover clinical trial costs for medical technologies.
• Implement congressionally mandated reforms to reduce long delays in the Medicare patient appeals process. 
• Adopt key recommendations from an Institute of Medicine report to improve the timeliness of Medicare payment decisions for innovative diagnostic tests.

"This bill will help Medicare patients maintain their access to new and innovative technology," says Dr. Stephen Ondra, director of spine surgery, department of neurosurgery, Northwestern Memorial Hospital. "Without this access, we start Medicare patients down a slope toward being second class citizens when it comes to healthcare."

While lack of access is frustrating, there are indications that 'old school' procedures and technologies may not even be as cost effective as the new technologies.

"I think the more pertinent question that we should be asking is, 'what is the cost of not making new technology available to Medicare patients at a reasonable pace,'" Ondra says. "When you look at the long-term cost, many of these technologies become budget-neutral. Often not using new technology is penny-wise and pound-foolish."

Ondra says a good example is bone morphogenic protein (BMP), a new therapy used in reconstructive spine surgery.  BMP is a protein that induces the body to make more bone. By using BMP, surgeons no longer need a second site to chisel and gouge bone from the hip for fusion.

"Everyone is in favor of this new approach because we don't need a second surgery," Ondra states. "The problem is BMP costs $3000 a dose. But there's been a study on BMP and at two years the cost to insure is neutral because of the decreased recovery time, earlier hospital discharge, reduced need for rehabilitation, fewer complications and decreased medications."

Outside of those upfront costs are some very real 'human savings' - people are in less pain and are less dependent on their families for care during recovery.

Ondra explains another example -- minimally-invasive technology that places rods and screws in the spine through small holes or 'ports' rather than making a big 'open' incision. Open procedures require longer healing times and hospital stays and carry higher post-surgical risks. By not reimbursing for this technology, Medicare patients suffer physically. And their providers suffer financially.

Seeing red

The problem doctors and hospitals face is most are already taking a financial loss on Medicare patients.  In Ondra's area of expertise, adult scoliosis surgery, he reports that his hospital loses an average of about $18,000 per Medicare case. 

"When we try to add in new technology, it really becomes something that's unsupportable from the institution's point of view," Ondra says. "Despite popular opinion, one-third of all hospitals operate in the red.  Another third have less than a three percent profit margin."

"As a surgeon, I am faced with this horrible dilemma," Ondra says. "Do I provide the latest technology to patients that is going to shorten their recovery at the risk of bankrupting the system and not being able to provide care to anyone in the future? Or do I give them older technology that will lengthen their recovery and perhaps result in long-term pain in their hip but not jeopardize the system financially?"

Ondra makes the analogy that if there was a device that eliminated automobile tailpipe emissions, it would be ridiculous to only put it in luxury cars.

"It should be available to everyone because air pollution affects everyone," Ondra urges. "All of us are going to eventually need healthcare. Medicare is important to all of us because eventually we will all be on Medicare. And virtually everyone knows or loves someone who is on Medicare. So this is not an issue of convenience or luxury. This is an issue of our lives, our well-being and our quality of life."

Dole agrees.

"Every moment of life is precious, but as the years go by you come to realize just how precious," Doles says. "No American should have to suffer or die because Medicare's bureaucracy takes too much time to bring improved medical technology to people in need.  That's why the Medicare reforms proposed by this legislation are critical."

Spotlight Health is the leading creator of celebrity-featured health-issue awareness campaigns, connecting consumers with impassioned celebrities whose personal health battles can open eyes, dispel myths and change lives. Spotlight Health helps sufferers and caregivers meet the challenges of difficult health circumstances with understandable, in-depth medical information, compassionate support and the inspiration needed to make informed healthcare choices.

Created: 3/12/2003  -  John Morgan & Stephen A. Shoop, M.D.