Fate of essential cardiac services for privately insured patients imminent

MedTech News: The application deciding the fate of essential cardiac services for privately insured patients is on the horizon.

The Medical Technology Association of Australia (MTAA) put forward the application to Medical Services Advisory Committee (MSAC), due to be considered at the March 2023 meeting, to assess and advise on the reasonable cost to industry for Cardiac Implantable Electronic Devices (CIEDs) technical support services provided by Industry Employed Allied Health Professionals (IEAPs) for patients who have their CIED funded through private health insurance.

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.

The medtech industry contends that PL benefit reductions for CIEDs, in the context of the Prostheses List reforms, will reduce their ability to provide technical support services for patients implanted with these medical devices. The MTAA application is representing Medtronic, Abbott, Biotronik, MicroPort CRM and Boston Scientific.

Patient safety and access to essential cardiac services must take priority over pricing review: Tanya Hall, CEO of hearts4heart and Dr Michael Davis, Consultant Cardiologist

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 be in the range of $86 million and $125 million, with a median total cost of $102.98 million, according to a KPMG’s analysis.

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.

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.

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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