WASHINGTONInsufficient evidence exists to support or reject the
inclusion of routine skin cancer screenings in Medicare coverage,
according to a new report by the Institute of Medicine (IOM). A
second IOM report urges the Health Care Financing Administration
(HCFA) to end uncertainties about whether it will cover routine care
for patients taking part in clinical trials by stating that it will.
Medicare already covers skin examinations sought by beneficiaries who
are concerned about changes in a mole or some other skin feature, an
IOM committee noted in the report Extending Medicare Coverage
for Preventive and Other Services. However, according to the
report, there is currently no evidence for or against the
effectiveness of screening patients who have no symptoms.
The report also favored preventive dental care for head and neck
cancer patients, which reduced serious damage to the jaw caused by
radiation therapy. Currently, Medicare only covers extractions for
these patients, although extractions may result in worse health
outcomes for some patients, it said.
The committee also concluded that treating leukemia patients with
acute dental infections before chemotherapy may reduce life-threatening
infections later, but said it lacked evidence to make a
recommendation for dental coverage of lymphoma patients.
Covering Clinical Trials
A second IOM committee addressed the uncertainty and controversy
surrounding Medicares policy on reimbursing for routine care
needed by its beneficiaries who participate in clinical trials. Many
people have interpreted the Medicare statute as excluding coverage
for such care, although much of this care would be necessary whether
a patient was part of a clinical study or receiving a standard
HCFA has never issued explicit guidance regarding reimbursement in
clinical trials, except in the case of medical-device studies, the
committee stated in the report Extending Medicare Reimbursement
in Clinical Trials. And in spite of concerns that Medicare will
not reimburse for routine care, health care providers frequently
submit claims for beneficiaries taking part in trials, and usually
the claims are paid.
The committee recommended that HCFA end all uncertainty about
reimbursement for coverage in routine care in clinical trials because
it is to the agencys advantage to ensure that the medical
interventions for which it pays are effective. Medicare patients
enrolled in managed care plans should receive the same reimbursement
in clinical trials as those in the traditional Medicare
fee-for-service program, the panel said, but this coverage should not
exceed the managed care contracts limits.