Ad Hoc Cholesterol Coalition

Following is the first information memorandum from the AHA regarding the petitioning of Medicare to include payment for Cholesterol Screening Services. SELA is a member of the coalition.

If you would like to join as an individual please complete and fax this form. You could also see if your institutions would be interested in joining the coalition.

Which test, and how often?

Several of you have asked which specific cholesterol test we are pushing for under this legislation. In the attached bill language you will note that we are not advocating a particular test/tests. The American Heart Association's proposed bill leaves it up to the discretion of the Secretary of HHS to determine which test/tests are most appropriate. This will permit flexibility over time as science and best practices evolve. If we were to state "test X is to be used," a newly developed and cheaper test may accidentally be cut-out in the future and an act of Congress would be need to update federal statute. We have taken a similar approach to the question of "testing frequency." That said, we will encourage the Secretary to use USPSTF and NHLBI's APT(III) guidelines on cholesterol to arrive at that decision.

Cost: How much will we save?

The American Heart Association has begun to look at the cost/savings of this proposal, but those studies have not been completed. Also, our through review of the current literature has not provided much in the way of cost-benefit analysis to help answer that question.

To further complicate the issue, the Congressional Budget Office and the Office of Management and Budget (CBO and OMB) don't generally "cost out" federal legislation that is preventative in nature as "saving the Medicare system money." EXAMPLE: While it may be true that discovering elevated cholesterol levels may reduce cardiovascular risks, the resulting doctor visits may end up costing Medicare MORE than if the patient had died without ever knowing he/she was at risk. If the discovery of high lipid levels prevents massive disability from a stoke or a long hospital stay, THAT would save money. Still, because there is so much guesswork, Congress only looks at what the test will cost the system, not what we THINK it will save.

That said, we are not focused on the cost/savings issue as much as we are focused on the huge impact that this measure will have on limiting disability from stroke, preventing heart attacks, preventing premature death, and greatly improving the quality of life for millions of seniors.

What can I do to help?

Attached is an important form for you to fill out. Please fax it back to me with those items you would like to be involved in noted on the sheet.

Also, feel free to send any fact-filled state/regional studies to us. We are always looking to fill our library with more artillery that can further make the case to Washington that this is a good idea. For example; "at clinic X, we found that 1,000 of the 1,400 seniors who were found to have elevated lipid levels took evasive action and lowered their cholesterol." Or, "of the 400 patients I see, 32% have lived longer healthier lives after finding they had high cholesterol."

Thank you for offering to help us move forward on this effort.

Karl B. Moeller
Government Relations Manager
American Heart Association
1150 Connecticut Ave, NW # 810
Washington, DC 20036
(202) 785-7905
karl.moeller@heart.org

The legislative text included below is the Coalitions "suggested language," and we are meeting with Senate Finance Committee members next week to discuss the measure.

A BILL

(a) IN GENERAL.- Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended-

(1) by inserting after subparagraph (s)(2)(V) the following new subparagraph:

"(W) cholesterol and other blood lipid screening tests (as defined in subsection (ww));

(2) by adding at the end the following new subsection

"Cholesterol and Other Blood Lipid Screening Tests

"(ww) (1) The term 'cholesterol and other blood lipid screening tests' means diagnostic testing of cholesterol and other lipid levels of the blood to detect the need for further diagnostic evaluation or treatment of abnormal cholesterol and other lipid levels.

"(2) The Secretary of the Department of Health and Human Services shall establish standards, in consultation with appropriate organizations, regarding the frequency and type of cholesterol and other blood lipid screening tests that an individual shall be eligible to receive under this title. Such standards shall apply only to screening tests and shall not limit coverage of cholesterol and other lipid testing for individuals who otherwise qualify for coverage of diagnostic cholesterol and other lipid testing based on established clinical diagnoses.

(b) EFFECTIVE DATE.- The amendments made by this Act shall be effective immediately upon enactment.

Explanation of Provision: This provision is designed to accomplish the following three objectives: 1) establish coverage for periodic screening of cholesterol and other blood lipid levels for all Medicare beneficiaries; 2) provide the Secretary of the U.S. Department of Health and Human Services (HHS) with the discretion to establish and update standards regarding the frequency and type of such testing to reflect the evolving standard of care, based on consultation with appropriate organizations; and 3) avoid inadvertently changing Medicare's existing coverage for beneficiaries with known disease who currently receive coverage of diagnostic testing for cholesterol and other blood lipid levels.

Periodic screening of cholesterol and other blood lipid levels in elderly and non-elderly individuals is recommended by the American Heart Association, the National Heart, Lung, and Blood Institute (part of HHS) and the U.S. Preventive Task Force (sponsored by HHS). Current Medicare policy only covers cholesterol and other lipid testing for patients who already suffer from known disease, such as abnormal cholesterol and lipid levels, heart disease, stroke or other disorders associated with cholesterol and lipid abnormalities.