April 12, 2011
It is a challenge for providers to decide which emerging technologies to adopt before they become mainstream. CMS has focused on supporting new technologies that offer improved outcomes and lower long-term costs by offering providers the financial incentive to adopt these technologies when they first enter the market. After a few years of aggressive reimbursement, the payment levels are readjusted to reflect the true cost of the technology. One recent example in new technology incentives is electronic brachytherapy, a revolutionary new technology designed to eliminate the need to physically place a radioactive seed within the patients body.
I checked with several clinical trials and found that electronic brachytherapy has multiple advantages over external radiation and iridium seed placement, including a much shorter therapy cycle. When compared to external radiation, the treatment course lasts five days instead of up to seven weeks. Additionally, electronic brachytherapy is a more accurate therapy than iridium seed placement, which decreases the damage to healthy tissue, a critical aspect directly related to outcomes when treating bladder and endometrial cancers.
Due to these improved outcomes, CMS assigned electronic brachytherapy very aggressive reimbursement (APC 1519, $1,750 per treatment) one year after it was first approved in 2006. By 2010, the payment level has been readjusted to $710. This represents a drop in almost 60%, close to the true cost of the therapy.
Keep in mind that electronic brachytherapy is not a unique scenario. Digital mammography, green light lasers, and IMRT have seen similar reimbursement cycles in the past. According to CMS New Technology reimbursement rules, the high initial payment level is typically left in place for three to five years until a true cost of the procedure has been identified. Considering a budget cycle lasts up to a year, its good practice to be aware of approvals that hold promise well in advance.
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