Medicare officials have acted against expert medical directives by denying transplant recipients access to crucial, non-invasive diagnostic tests. Those tests are essential and effective for the early detection of organ rejection. Nevertheless, they are being rejected for more invasive biopsies under much more limited circumstances. Unelected bureaucrats have thereby contradicted the medical consensus supporting a preference for non-invasive tests.
This month’s reporting is based on a Freedom of Information Act (FOIA) request made by the Health Equity in Transplantation Coalition (HEiTC). The request eventually turned up evidence that Medicare contractors restricted these tests, potentially jeopardizing patient health — particularly affecting minority communities, who represent a substantial portion of transplant recipients.
Contractors for the Centers for Medicare and Medicaid Services cut access to tests for transplant patients that could show early signs of organ rejection despite expert physicians advising the opposite, a new report has found.
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— The Hill (@thehill) April 20, 2024
In November 2022, five out of six surveyed experts testified to the clinical benefits of these tests for routine surveillance. This contradicts the March 2023 Medicare update, which severely limited their availability. The change stipulates that transplant recipients can only receive these tests instead of a biopsy, not in conjunction with regular monitoring as was previously recommended.
Since the report was published, both Republicans and Democrats have been questioning the rationale behind the decision to deny the diagnostic tests. Patient advocates argue the current system is denying life-preserving care to tens of thousands of Americans.
Critics, including advocates and lawmakers, suggest that these decisions reflect a troubling trend in healthcare where cost-cutting measures trump patient needs. Medicare’s financial condition is increasingly concerning as the program grapples with budgetary pressures that are only expected to intensify in the coming years.
The Medicare Hospital Insurance (HI) trust fund, which finances Part A benefits such as inpatient hospital care, is projected to be depleted by 2028. At this point, incoming payroll taxes will cover only 90% of the program’s costs. That only indicates two options to maintain service levels — spending cuts or increased funding.
Without significant changes, such as restructuring how services are paid for or adjusting benefit levels, Medicare’s financial health will remain precarious. Transparency and honesty about the situation would go a long way in addressing the crisis. Sadly, those qualities remain in short suppl among politicians.
