Medicaid Cuts

Pollice Verso: How State Legislators try to revive an ancient custom


A recent article in Wall Street Journal, Health Studies Cited for Transplant Cuts Put Under the Knife, http://online.wsj.com/article/SB10001424052748703395204576024213729831704.html, highlights the looming issue of cost control.
Faced with skyrocketing healthcare costs, states will be forced to make tough decision on care allocation and coverage.
Arizona already has taken drastic steps to drop Medicaid coverage for some organ transplants as the state tries to plug a $1 billion gap in its health-care budget for next year. The state agency that recommended that Arizona stop paying for transplants of lungs and, for certain patients, hearts and livers, has defended the move by citing studies and figures that it says demonstrate the ineffectiveness of the procedures. But the state agency has gone a step further by selecting studies that proves the point that certain transplants are ineffective. To make its case for cuts, the Arizona agency cited several sets of numbers. In dropping coverage of liver transplants for patients with hepatitis C, the state said liver recipients suffer recurrence of the disease at a rate of 100%. And the state argued that candidates for lung transplants would live just as long with other medical care, citing data from university studies. Several transplant experts, however, point to flaws in the data and the way the state's Medicaid agency, called the Health Care Cost Containment System, has used the figures. Arizona "used data that were outdated or data that made no sense, or they misinterpreted or misrepresented what experts said," says Michael Abecassis, director of Northwestern University's comprehensive transplant center and president of the surgeons group. For lungs, a crux of the state's position was a 1995 study of 49 patients at the University of Washington, 25 of whom received transplants; the rest were waiting at the time of the study. The study concluded that transplant recipients would live half a year longer than those who didn't get a new lung, but the difference wasn't statistically significant—in part because the sample size was so small. Also, researchers didn't wait to track patients' survival, instead extrapolating long-term mortality rates from deaths and sickness in the short run.
So, what’s the solution? States should not be permitted to arbitrarily decide what services can be covered under the states Medicaid program. Instead, they should follow evidence-based data and, most importantly, comparative effectiveness research data.
Otherwise, we will revert to the Pollice verso (thumbs turned) used in ancient Rome by the crowd to indicate if the defeated gladiator should be condemned to death. Soon we do not need gladiators to revive this custom. We just need legislators who will decide the fate of condemned Medicaid recipients.

Yours

Bernd