Doctors conduct a heart procedure. Photo: Jeff Gritchen/Digital First Media/Orange County Register via Getty Images
Hospitals, doctors and medical device companies have successfully lobbied Medicare to abandon a proposed 30% cut in payments for certain surgeries involving heart pumps.
Why it matters: Regulators attempted to rein in spending on a powerful and well-financed niche, but the industry managed to preserve its payments yet again.
Where it stands: The Centers for Medicare & Medicaid Services in April proposed cutting rates for inpatient surgeries with "other heart assist system implants" by almost 30%.
- Instead, in the final rule, federal officials backtracked and kept payments where they've been since 2018. Officials cited an "outlier circumstance" tied to coding data, and the agency did not comment beyond what was written in the rule.
- These procedures often involve the Impella, a heart pump made by Abiomed, and usually cost Medicare around $75,000.
What they said: Many hospital systems, trade groups and surgeons argued that "extensive coding changes" over the past couple years have created billing inaccuracies, and therefore Medicare should not touch the payments because such a change would be based on flawed data.
This is wash, rinse, repeat in health care, as the industry deluged the federal government with opposition and got what it wanted.
- Abiomed was among the loudest critics of the proposal. And it had a lot to lose, considering Medicare is "particularly significant to our business," Abiomed has told investors.
- Several heart doctors used almost identical language in portions of their letters to Medicare, and have also have accepted tens of thousands of dollars in honoraria and other fees from Abiomed and other device makers, according to the federal database that tracks payments between industry and doctors.
- An Abiomed spokesperson sent Axios a statement reiterating most of the points in its comment letter to Medicare. Abiomed did not make the author of its letter, Stacey Bunk, available for an interview, or answer follow-up questions about the company's payments to doctors. Multiple doctors did not respond to interview requests.
The bottom line: Big Heart fought off a big change to Medicare's payment system, and the main justification was everyone is bad at coding.