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Medicare pays for intestinal transplants

Medicare now pays for intestinal transplants for some elderly and disabled patients at three government-approved transplant centers.

The policy change, which became effective April 1, 2001, will affect relatively few of the nation's 40 million elderly and disabled Medicare beneficiaries. However, the decision is a big step in advancing patients' access to proven new treatments and technologies, according to Tommy G. Thompson, secretary of the United States Department of Health and Human Services.

Patient advocates hope the decision will prompt private insurers to follow suit.

Patient advocates hope the decision will prompt private insurers to follow suit. "It's frequently the case that private insurers often follow the government's lead when deciding which procedures they will cover," says Richard Coorsh, spokesperson for the Health Insurance Association of America. "However, in this case, it will have to be decided from carrier to carrier."

Intestinal transplantation replaces the small intestine in people whose digestive tracts cannot absorb nutrients, a condition caused by bowel injury or disease. To qualify for a transplant, a patient with total intestinal failure must be deemed unable to tolerate "total parenteral nutrition" (TPN), a procedure that allows nutrients to be fed to the patient intravenously. Patients are frequently unable to tolerate long-term TPN because the process may cause blood-clotting, infection, or liver failure, according to health officials with the Centers for Medicare & Medicaid Services (CMS, formerly the U.S. Health Care Financing Administration (HCFA).

Medicare beneficiaries eligible for an intestinal transplant must have the procedure performed in a hospital that performs at least 10 such transplants a year and has a one-year survival rate of 65 percent. Currently, the hospitals approved by CMS to perform the operation are the University of Pittsburgh Medical Center in Pennsylvania, the Jackson Memorial Hospital Transplant Center in Miami, Fla., and the Mt. Sinai Hospital in New York.

Intestinal transplantation is a relatively new technology that has been pioneered in this country primarily at the University of Pittsburgh School of Medicine, according to CMS officials. Fewer than 1,000 transplants have been performed in the U.S., with approximately two-thirds of the patients being children.

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