In an era of shrinking budgets and increasing health care expenditures, we need to find ways that will encourage the use of higher value treatments and discourage the overuse of low value treatments.” ~ Dr. Teresa Fama
Berlin, Vt – Dr. Teresa Fama, a Rheumatologist with Central Vermont Medical Center group practices, was an inaugural member of the New England Comparative Effectiveness Public Advisory Council (CEPAC). CEPAC, formed in March 2011, is a regional body whose goal is to provide objective, independent guidance on the application of medical evidence to clinical practice and payer policy decisions across New England.
At its December 2011 meeting, CEPAC voted 10 to 5 that the evidence was adequate to demonstrate that for patients with treatment-resistant depression rTMS was as good, or better, than usual care (i.e. general supportive psychotherapy with or without continued use of antidepressant medication). CEPAC also voted 9 to 6 that the evidence was adequate to demonstrate equivalent or superior outcomes for rTMS compared to electroconvulsive therapy (ECT). CEPAC then reviewed evidence on the cost-effectiveness and potential budget impact of rTMS and the majority voted that, at current Medicare reimbursement rates, the use of TMS represents “reasonable value” when compared to usual care and a “low value” when compared to ECT.
The Medicare Administrative Contractor for most of New England, NHIC, Corp, has issued a final local coverage decision granting first-in-the-nation Medicare coverage for repetitive transcranial magnetic stimulation (rTMS) for patients with treatment-resistant depression. The new coverage policy, which takes effect in March, reverses a non-coverage draft policy posted in November 2011, and represents the first positive local Medicare coverage policy for rTMS in the nation. In describing the factors considered for this policy change, the Medicare Contractor cited numerous comments and statements received from patients and clinicians, several of which cited the comparative effective review produced by the federal Agency for Healthcare Research and Quality (AHRQ), supplementary analyses of this report prepared for the New England Comparative Effectiveness Public Advisory Council (CEPAC), and the votes taken by the CEPAC as part of its public deliberation on the evidence.
Dr. Fama added, “As a practicing clinician, I think we lack important information on the value of treatments we provide. Comparative effectiveness studies look at whether there is adequate evidence that a new or existing treatment is as good as or better than other treatments. In an era of shrinking budgets and increasing health care expenditures, we need to find ways that will encourage the use of higher value treatments and discourage the overuse of low value treatments.”
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