For Those Who Oppose a Public Option
Opponents of a 'public option' have complained that it will result rationing and denial of care, need to read this. It is a response by Medicare to requests for funding particular uses of MRIs. It's long, but at least scan it and you will get a sense of how Medicare makes decisions about guidelines.
From: Fredrick H (MD, PhD, JD)
Sent: Tuesday, June 30, 2009 10:35 PM
Subject: The following may represent the gold standard of reasonableness in guidance by health plans
Subject: The following may represent the gold standard of reasonableness in guidance by health plans
_______________________________________
The Centers for Medicare and Medicaid Services (CMS) reviewed evidence that speaks to MRI assessment of cardiac blood flow asking if it helps to improve patient outcomes when employed in the management of a Medicare beneficiary’s medical problem.
Here's what CMS had to say in "Assessing the Relative Magnitude of Risks and Benefits""Generally, an intervention is not reasonable and necessary if its risks outweigh its benefits. Health outcomes are one of several considerations in determining whether an item or service is reasonable and necessary. CMS places greater emphasis on health outcomes actually experienced by patients, such as quality of life, functional status, duration of disability, morbidity and mortality, and less emphasis on outcomes that patients do not directly experience, such as intermediate outcomes, surrogate outcomes, and laboratory or radiographic responses. The direction, magnitude, and consistency of the risks and benefits across studies are also important considerations. Based on the analysis of the strength of the evidence, CMS assesses the relative magnitude of an intervention or technology’s benefits and risk of harm to Medicare beneficiaries."Proposed Decision Memo for Magnetic Resonance Imaging (MRI) (CAG-00399R)
Rhetorical Question: Are any private insurers or HMOs this methodical, rational and open about their coverage policies?
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