OPINION:
With more than 160,000 clinical trials exploring the tools, treatments and technologies we need to fight disease and improve health outcomes, the innovation in medical science is creating possibilities for patients that didn’t exist a few years ago.
Prostate cancer, the disease I’ve treated for 30 years as a urologic surgeon, offers an incredible example of how the rapid evolution of medical technology can benefit patients. The benefits are reaped, however, only if Medicare’s payment system can keep pace with innovation.
At the beginning of my medical career, screening and treatment options for prostate cancer were relatively limited. Today, the technology to identify, diagnose and treat prostate cancer has significantly improved.
Nuclear medicine can assist with the accurate diagnosis of diseases, such as prostate cancer and Alzheimer’s disease, at earlier, more treatable stages by using small amounts of radioactive materials, known as diagnostic radiopharmaceuticals, to provide detailed images of what is happening inside the body at the molecular and cellular levels.
This is known as nuclear imaging, which allows physicians to identify abnormalities earlier in the progression of a disease.
As a result, they may gather more precise clinical information that would otherwise be unavailable, eliminating the need for invasive procedures or additional repetitive diagnostic tests.
Early detection is key to managing and treating life-threatening diseases such as prostate cancer, as well as Alzheimer’s and Parkinson’s diseases, advanced breast cancer, neuroendocrine tumors and cardiac conditions.
The detailed information provided through innovative nuclear imaging helps to inform provider decision-making surrounding early intervention strategies and treatment monitoring, with the goal of optimizing health outcomes for patients. Another advantage to accurate early diagnosis is that it gives patients and their loved ones more time to adjust and plan for the impact of these devastating diseases.
Current Medicare policy is leaving too many patients behind by making these diagnostic procedures largely unavailable in clinical practice. The Centers for Medicare & Medicaid Services bundles the diagnostic radiopharmaceutical drugs used in these nuclear imaging procedures through what is referred to as a “packaged payment system.” The centers’ payment structure averages the costs of similar nuclear procedures but fails to fully account for the cost of newer drugs.
Since the cost of diagnostic radiopharmaceuticals varies widely (especially as newer drugs come on the market), this system forces the centers, and thus taxpayers, to significantly overpay for low-cost drugs and underpay for newer, highly advanced radiopharmaceuticals.
Given this structure, hospitals end up losing money when they perform scans using these more advanced drugs. Consequently, health care facilities face the difficult decision of taking a financial loss in order to offer these nuclear procedures to Medicare beneficiaries.
This payment disparity, stemming from a flawed, outdated policy, ultimately limits doctors’ ability to offer these procedures and takes the most cutting-edge diagnostic options away from patients. It’s a perverse, anti-innovation payment structure that ultimately denies the scientific progress we should encourage in the medical community.
That is why, along with my colleagues Reps. Gregory Murphy, Scott Peters and Terri Sewell, I’ve worked to introduce a solution: the Facilitating Innovative Nuclear Diagnostics (FIND) Act of 2023. Our bill would help ensure that all providers can utilize appropriate diagnostics to deliver targeted, cost-efficient care.
If enacted, this bipartisan, budget-neutral bill would more closely align reimbursement with procedure cost — giving patients access to the diagnostic tools they need when they need them.
We can’t fight tomorrow’s battles with yesterday’s medical technologies. It’s past time that patients experience the benefits that breakthrough technologies, such as nuclear imaging, can provide. I urge all members of Congress to join me and my colleagues in supporting the FIND Act and ensure that Medicare payment policy keeps pace with innovations in medical science.
• Congressman Neal Dunn represents Florida’s 2nd Congressional District.
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