Medicare News
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| Sunday, April 01, 2001 | CMS Office of Public Affairs 202-690-6145 |
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MEDICARE BEGINS COVERAGE OF INTESTINAL TRANSPLANTS
Medicare coverage of intestinal transplants for beneficiaries with irreversible intestinal failure began today, with the implementation of a National Coverage Decision by the Health Care Financing Administration (HCFA). These procedures will be available at three transplant centers recently approved by Medicare.
"This decision means new hope - and potentially life-saving transplants - to the Medicare beneficiaries who may qualify for this kind of treatment," HHS Secretary Tommy G. Thompson said. "Although only a few people may benefit from this coverage, it reflects our commitment to providing all of the nearly 40 million Medicare beneficiaries with access to proven new treatments and technologies."
The transplant centers approved by Medicare to perform intestinal transplants are the University of Pittsburgh Medical Center, Jackson Memorial Hospital Transplant Center in Miami and The Mt. Sinai Hospital in New York.
The procedure will benefit the small portion of the Medicare population who suffer from the inability of the intestine to absorb nutrients.
"HCFA's new coverage process is helping Medicare make the right decisions, based on scientific evidence, on when the program should cover new items, services and procedures," said Jeffrey Kang, M.D., director of HCFA's Office of Clinical Standards and Quality. "By expanding coverage when proven effective and beneficial, we are improving the health care available to the senior citizens and disabled Americans who rely on Medicare."
Patients with total intestinal failure survive by getting their nutrients intravenously, a procedure called total parenteral nutrition (TPN). However, frequently patients are not able to tolerate long-term TPN because the process may cause liver failure, the patients veins become clotted, the lines to deliver the nutrients become infected, or the process causes severe dehydration.
Intestinal and multi-visceral transplantation restores intestinal function in patients with irreversible intestinal failure who cannot tolerate TPN. The procedure can be performed on the small bowel alone or in combination with various parts of the digestive track, such as the liver, stomach, pancreas or colon.
In implementing Medicare coverage, HCFA has attempted to ensure the safety of Medicare beneficiaries by covering the procedure in transplant centers that have met standards of experience and have demonstrated successful outcomes on a majority of patients. To qualify, centers must have performed 10 transplants per year with a one-year actuarial survival rate of 65 percent. All three approved centers met these standards.
Intestinal transplantation is a relatively new technology that has been pioneered in this country primarily at the University of Pittsburgh School of Medicine. Fewer than 1,000 transplants have been performed in the United States, with approximately two-thirds of the patients being children.
In making its national coverage decision, HCFA conducted a review of the available literature on the procedure and contracted with the federal Agency for Research and Quality for a technology assessment. Prior to this decision, few insurers routinely covered the procedure.
