Medicare Denies Transplant Test Against Doctors’ Advice

So much for “following the science.” Newly released documents indicate that bureaucrats affiliated with the Medicare program ignored advice they solicited from medical experts in their efforts to deny patients care. Worse yet, the individuals with disabilities who were harmed often came from minority households — the same groups the Biden administration claims to be helping with its “equity” agenda. It’s but the latest signal of how the left will use rationing tactics to deny patients costly care.

The documents, uncovered via a Freedom of Information Act (FOIA) request, surround decisions by Medicare contractors regarding coverage of a blood diagnostic test designed to detect signs of organ rejection in kidney, heart, liver, and lung transplant recipients. Last year, one contractor reduced coverage of the tests, stating that patients could only receive them in lieu of a more invasive biopsy.

But the blood screening tests were designed as an early warning signal well before a biopsy was needed — they were meant to be used more regularly for better monitoring of rejection signs. By equating these less invasive tests to biopsies, patients would only receive the blood tests once signs of organ rejection and damage had become more obvious, making this innovative screening tool of little benefit to patients.

Doctors understand the value of this treatment, even if the Medicare contractor deliberately ignored their advice. As The Wall Street Journal reported, five of six transplant physicians surveyed by the Medicare contractor agreed that the evidence supports surveillance use for kidney patients, and all six clinicians believed that the tests could help prevent the need for biopsies in otherwise-healthy transplant recipients not showing signs of rejection.

In short, medical experts believe this new screening treatment could keep organ transplant recipients in better health, and avoid subjecting them to unnecessary and invasive procedures such as biopsies to monitor their condition. It makes perfect sense — except to government bean-counters like those focused on Medicare’s purse strings.

Not only did the Medicare contractor make a decision that contradicted the opinions of its medical experts, but he also fought against disclosing those experts’ opinions to the public via a FOIA request.

Caring for the Elderly and Disabled

As the mother of a child with cystic fibrosis, I worry my daughter may one day need a lung or kidney transplant to save her life. And as an advocate for those with disabilities, and former member of the National Council on Disability, I worry about what decisions like those surrounding this screening test — which seemed obvious to Medicare’s self-selected experts — say about our country’s priorities.

I remember the Obamacare debates back in 2009, when President Barack Obama responded to a woman asking about the care for her elderly but healthy mother by saying, “Maybe you’re better off not having the surgery, but taking the painkiller.” I fear that this mentality, of casting off the old, vulnerable, and “less valuable,” is growing in our society — and directly led to this contractor’s medically indefensible decision.

The Medicare program faces financial shortfalls, and yes, it needs reform. But there are far better ways to modernize Medicare than to deny care to vulnerable patients solely on cost grounds, and then try to hide the evidence from the public’s gaze. Transplant recipients deserve better — and so do all of us.

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Mary Vought is the vice president of communications at the Heritage Foundation and a senior fellow at Independent Women’s Forum.

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