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Billions paid out in the US to replace defective heart devices

Medicare in the US has paid at least $1.5bn over a decade to replace seven types of defective heart devices. According to a report in The New York Times, the devices apparently failed for thousands of patients.

A survey by the inspector general’s office for US Health and Human Services said officials needed to do a better job tracking these costly product failures to protect patients from harm. More detailed reporting could lead to earlier recognition of serious problems with medical devices and faster recalls of all types of “poorly performing” ones, the inspector general’s office said.

The report says the survey marks the first effort by anyone in government to assess the losses to taxpayers and patients 65 and older from medical gear that proves faulty. Officials said the $1.5bn lost from the seven devices from 2005 through 2014 was a “conservative estimate.” Patients also paid $140m in out-of-pocket costs for this care, the survey noted.

According to the report, the survey found that nearly 73,000 people on Medicare had one of the seven devices replaced because of recalls, premature failures, medically necessary upgrades or infections. It did not outline specific injuries that patients suffered as a result. The inspector general did not identify the manufacturers of the seven devices, but officials said they included implanted cardio defibrillators and a pacemaker that had either been recalled because of flaws or had “prematurely failed.” Pacemakers and implantable defibrillators are small devices placed under the skin to help treat irregular heartbeats.

The report says how best to identify these defects and cut Medicare spending associated with fixing them has been under consideration at various times since 2007. But it remains a contentious issue.

The inspector general recommended that hospitals and doctors be required to submit detailed information identifying failed devices, like serial and batch numbers, during the billing process. “This could help reduce Medicare costs by identifying poorly performing devices more quickly, which could also protect beneficiaries from unnecessary costs and improve their chances of receiving appropriate follow-up care more quickly,” the survey said.

David Lamir, an official in the inspector general’s Boston office, said the $1.5bn figure represented a “drop in the bucket” of the true costs to Medicare from medical products that malfunction. He said device failures not only waste money, but also can expose patients to a “high risk of illness,” including needless surgeries.

The survey said that medical device recalls nearly doubled from 2003 through 2012 and noted that they have probably cost Medicare billions of dollars. In the past five to six years, more than 200 cardiac devices have been recalled, according to the inspector general’s office. In most cases, manufacturers withdrew their products voluntarily after reports surfaced of injuries or malfunctions. Device makers are required to report problems they learn of, often from doctors and hospitals, to a database run by the US Food and Drug Administration.

Diana Zuckerman, president of the National Centre for Health Research who has testified before Congress on device safety, said in the report that her organisation supports making hospitals report malfunctioning devices when they seek Medicare payments to cover an implant surgery. She said the change would help officials pinpoint faulty devices before issuing a recall for tens of thousands of products in patients. “It would be much more obvious much more quickly which implanted devices were causing problems,” she said. Zuckerman noted that the survey did not touch on other high-profile device failures, like metal-on-metal hip implants or vaginal mesh.

The report says medical device companies and some doctors have opposed tighter reporting, arguing that it would be costly and difficult to integrate with existing payment claim forms and might not yield useful information. “It is abundantly clear that data collected in electronic health records is a far superior and more cost-effective method for monitoring the performance of medical devices,” said Mark Leahey, who heads the Medical Device Manufacturers Association. The trade group represents nearly 300 device companies.

Leahey said that the electronic health record “captures the full clinical history of the patient, their changing health status and detailed information on their medical treatments,” including any surgically implanted devices.

But in written remarks included in the report, Seema Verma, the Centres for Medicare and Medicaid Services administrator, said the tighter reporting requirement was “under consideration” and that the agency would “carefully evaluate the potential that this policy would impose a burden on physicians unnecessarily.”

[link url="https://www.nytimes.com/2017/10/02/health/heart-devices-medicare.html?emc=edit_th_20171002&nl=todaysheadlines&nlid=42505380"]The New York Times report[/link]

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