Essential cardiac services have no sustainable funding for privately insured patients, says hearts4heart CEO

MedTech News: hearts4heart has launched a new campaign calling on the Federal Health Minister Hon. Mark Butler MP for a sustainable funding pathway for cardiac technical services so that patients who use cardiac implantable electronic devices (CIEDs) maintain access and are not forced to pay an out-of-pocket cost.

CIEDs have been listed on the Prostheses List since its formation in 2005. These medical devices diagnose and treat cardiac rhythm disorders. A modern and appropriately programmed CIED can provide therapy to the patient for 10 to 15 years before the battery is depleted.

In the public sector, patients are required to attend dedicated outpatient ‘pacemaker’ clinics in which the
cardiologist on roster supported by hospital technicians performs the CIED check. The costs are largely borne from within the hospital’s funding envelope. Medtech company support for the public sector is very minimal.

By contrast in the private sector, the patients are seen in the treating clinician’s private rooms for their CIED checks post implantation and for the life of the device. Clinicians are supported by device company staff (industry-employed allied professionals, IEAPs) who are highly qualified to provide this technical support. There are between 1 and 4 scheduled follow-up checks that occur each year for each patient, based on guidelines by the Cardiac Society of Australian and New Zealand (CSANZ). CIED manufacturers have been funding the services provided by IEAPs from the Prostheses List benefit for the CIEDs.

The total cost of IEAPs services by FY23 are expected to fall in the range of $86 million and $125 million, with a median total cost of $102.98 million, according to a KPMG’s analysis.

In the proposed Prostheses List reforms there is currently no clear funding pathway to maintain these technical services. These changes are expected to commence in July 2023.

Tanya Hall, CEO of hearts4heart told Health Industry Hub “Cardiac services must be equitable for all patients across Australia. Many Australians with private health insurance are paying top dollar, and still pay out-of-pocket costs. Patients are telling us they can’t afford an increase in out-of-pocket costs for cardiac services. If cardiac services are not adequately funded in the Protheses List reform and out-of-pocket costs increase, patients have indicated they would question the value of having private health insurance.

“hearts4heart is asking the Government to protect cardiac technical services and ensure there are no additional out-of-pocket costs for patients,” she said.

The medtech industry has argued that Protheses List benefit reductions for CIEDs (in the context of the Protheses List reforms) will reduce their ability to provide technical support services for these devices.

The Medical Technology Association of Australia (MTAA) has put forward an application to MSAC, following the agreement between the government and MTAA, to assess and advise on the reasonable cost to industry for CIED technical support services provided by IEAPs for patients who have their CIED funded through private health insurance. The application is representing Medtronic, Abbott, Biotronik, MicroPort CRM and Boston Scientific and is due to be considered by MSAC at its March 2023 meeting.

There are an estimated 220,172 Australian patients with CIEDs, increasing at a rate of approximately 18,000 a year. These technical services are provided on demand, without additional cost to patients, and are often provided in rural and regional clinics, meaning patients can access care without long commutes. Many regional locations have no service alternatives for their device checks.

Private health insurance, for those that can afford it, should be a safety net and give reassurance to cardiac patients.

According to hearts4heart, if the current funding arrangements are removed or reduced and no new funding pathway is established, the risks are:

• Patients will face additional out-of-pocket costs for accessing cardiac services
• Patients in rural and regional areas will have to travel to larger cities for their device checks, increasing the time, cost and stress of managing their condition
• Patients will have little option on when they can access cardiac services making it more difficult to manage their condition
• Cardiac patients’ private health insurance policies will cover less than they do now, but their premiums will remain the same or increase
• If patients decide to drop their private health insurance, they will be forced onto long waiting lists in the public health system which is already under significant stress
• Patients will have to wait longer for unplanned care such as MRIs, potentially delaying diagnosis and treatment of other health conditions
• Patients may skip their scheduled device checks which could negatively impact their health

Under current reform proposals, there is no guarantee these services will be covered by private health insurance after July 2023. Patients will face longer wait times, higher out-of-pocket costs and experience negative impact in cardiac health if a solution is not found quickly.

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