Medicare coverage expansion for carotid artery stenting procedures

Strategic Management Health Care

Feder, Barnaby J. (21 Oct 2005) "Report on Stents Could Increase Medicare Aid" Politics. The New York Times. Retrieved 23 Oct 2005 at http://www.nytimes.com/2005/10/21/politics/21stent.html

The National section of the October 21, 2005 edition of The New York Times has good news for the 200,000 Americans who undergo carotid-clearing surgery each year and the financing of such procedures for the Beth Israel Medical Center. Now, the once-complicated cleaning procedure that could only be performed by the most skilled physicians has become made easier, less invasive, and safer with the ability for physicians to use stents during the operations. Stents are metal cylinders used to prop open blood vessels to keep the vessels from closing again during surgery, after blockages have initially been cleared. Research indicates that the neck stenting, an emerging alternative to more invasive surgery to reduce stroke risks for patients with clogged carotid arteries, is technically less challenging in most cases than had been assumed.

Regulators originally approved marketing the stents only to a high-risk population who could not undergo normal surgery without great risk. Currently, Medicare is covering fewer than ten percent of these individuals undergoing the procedures with the use of stents. However, the new research is likely to spur an increase in aid to the population most at risk for clogged arteries, for both patients who must undergo stenting and now, patients who are not high surgical risks, but do not wish to endure the more invasive procedure without the use of stents.

The short-term financial implications for Beth Israel are initially, of course, that more patients will have Medicare coverage for the use stenting during carotid-cleaning surgery. There are other positive implications, too for the hospital over the long-term. In terms of staffing, as skill is less of a premium in stenting than previously thought, more physicians, and younger, training physicians can perform the procedure. This will free up the schedules of more skilled surgeons for other, more technically demanding operations. The procedure will also be able to be performed more frequently, as more physicians can accomplish it, thus enabling Beth Israel to expand the use of the surgery. As it is safer and less invasive, the surgery long run it may require less insurance for the hospital.