Government decides Medicare can reimburse certain diagnostics: how will it impact optical diagnostics?

Oregon Medical Laser Center News, Jan. 1998. by Steven L. Jacques

The recent decision by the Department of Health and Human Services (HHS) to allow Medicare reimbursement of certain medical diagnostics is a public acknowledgement that early detection can save lives and is a cost-effective health care measure. This may be good news for the biomedical optics community which is developing new diagnostic procedures using optical technologies such as optical biopsies based on fluorescence and light scattering, photon migration imaging, photoacoustic imaging, etc.

Under the Balanced Budget Act of 1997, signed into law on August 5, improvements in Medicare reimbursement of diagnostic procedures for colorectal cancer and breast cancer are now approved. The approved procedures are not optical in nature, but rather are traditional diagnostics which have been long championed by various groups for improved reimbursement status.

Two commentaries on the government action cited that the new law allows for reimbursement of new diagnostics which the Secretary (Secretary Donna E. Shalala, Department of Health and Human Services) finds appropriate. In particular, after 2001 new diagnostics for prostate cancer will be considered. Hopefully, this flexibility will be expanded to include new optical diagnostics which prove equivalence and advantage over approved diagnostics. (One commentary is by Michael J. Werner, JD , Amer. College of Physicians, in the ACP Observer. The other commentary is by Damaris Christensen, in the Medical Tribune News Service. See article links below. By the way, I myself have not yet found any such wording in the Federal Register.)

Is there perhaps a crack in the door for new optical diagnostics to prove their case and achieve acceptance for health insurance reimbursement?

An illustrative example of an optical diagnostic that may eventually benefit from this HHS action is the Optical Biopsy system for assessing colonic polyps based on fluorescence spectroscopy. The work of Michael Feld's laboratory at MIT and the work of Tom Deutsch's group at the Wellman Labs at Massachusett's General Hospital were pioneering efforts in establishing the feasibility of optical fiber-based fluorescence spectroscopy to distinguish benign from pre-cancerous polyps, and other groups have also contributed to this project. The MIT patent was licensed to SpectraScience Inc. which is now conducting clinical trials at Massachusetts General Hospital, the MAYO Clinic, and a local Minneapolis hospital.

The following is a listing of links to pertinent text, articles, and various press releases on the government action:

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