by Sean Ruck
, Contributing Editor | June 01, 2014
From the June 2014 issue of HealthCare Business News magazine
This month's main cover story touches in part on CMS's decision to approve only coverage with evidence development (CED) for Amyvid PET scans rather than full coverage.
It seems like CMS is coming under fire a lot and the Amyvid debate is no exception. Some believe the argument against reimbursement from CMS' perspective is based on the fact that Amyvid is used to measure beta-amyloid plaque load in the brain. A negative scan could help physicians rule out Alzheimer's in favor of other types of dementia while a positive would be grounds for further testing.. According to CMS, the coverage was denied because they say there isn't enough evidence to determine whether Amyvid could help improve outcomes for patients with early signs of cognitive dysfunction.
While I can see the logic in that - helping to diagnose someone with an incurable (but not contagious) disease as opposed to waiting for it to clearly manifest itself could be considered a waste of money. But in addition to the money saved by ruling out Alzheimer's and thereby preventing the waste of funds treating for a disease that isn't actually there to be treated, it's necessary to look beyond the on-paper expenditures. Ultimately, the benefit to society alone probably would offset the cost of full coverage. The knowledge gained even if it's a painful revelation, at least provides certainty and then allows everyone involved to consider plans for the future. In some cases, Alzheimer's hits fast and in others, it's a slower degradation of cognitive capabilities. And symptoms are also often attributed to senility or "old age." By the time it's clear what's really happening, lucid moments may be few and far between for the sufferer and loved ones may be denied the chance to truly say goodbye. Anyone who has had a family member with the disease knows what I mean when I say that Alzheimer's victims are gone before they're gone and getting alerted to the presence of the disease ahead of time I allowing time for closure would be priceless to some. Other practical matters like estate planning and end-of-life decisions could also be planned for, potentially saving the system money.
Finally, the fact that research continues in the search for a cure or at least better treatments of Alzheimer's means an effective way to help diagnose the disease will prove crucial if and when researchers have a breakthrough.
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Of course, Amyvid wouldn't be of use without imaging equipment. This issue also delves into the latest developments in molecular imaging (p. 34) as well as the options available to provide some radiopharmaceuticals (p. 44).
This issue also features an extended children's hospital spotlight section. The feature offers some fast-facts about some of the nation's leading hospitals catering to kids and an interview with Children's Hospital Association COO, Amy Knight. She sheds some light on why we need hospitals specifically catering to the smallest patients.