May 23, 2016
By: Kenneth Thorpe
One of the nation's largest Medicare contractors just decided that it won't cover a proven new heart monitor that tracks signs of heart failure. That's terrible news for millions of Americans suffering from cardiac disease.
It's also a terrifying example of what happens when contractors -- and the actuaries who rule their books -- take healthcare decisions away from patients and their doctors. Indeed, Medicare's reliance on private contractors to run the program exacerbates the nation's health disparities by denying Americans in certain states access to life-saving medical advances.
The Medicare administrative contractor, or MAC, that rejected this monitor is Novitas. In 11 states plus the District of Columbia, Novitas processes and pays Medicare claims. Ultimately, it's up to MACs -- not doctors or even Washington policymakers -- to decide if new treatments and technologies will be covered by Medicare in their jurisdictions.
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