Healthcare Reform Principles and Positions
Boston Scientific Principles
With rising healthcare costs and 45 million Americans lacking health care insurance coverage, Boston Scientific supports reform efforts that would lead to universal coverage for all Americans through a mix of private insurance and public programs that build on the strength of the existing system. We believe the responsibility for financing universal coverage should be shared by employers, the government, and patients.
We support value-based initiatives that incentivize greater efficiencies and improve the quality of healthcare without slowing the pace of innovation or limiting access to technologies and support a greater emphasis being placed on prevention and attaining and preserving wellness. Further, we support transparency of financial relationships between providers and industry.
Boston Scientific believes that these changes must be accompanied by individuals taking a more active and informed role in their healthcare choices, selecting the best therapeutic options at lower costs, whenever possible. We also believe that clinicians must be more informed with respect to the clinical effectiveness of various treatment options. Further, we believe that informed patients and clinicians will lead to a greater understanding on how to improve economic incentives that reduce spending and broaden availability.
Boston Scientific Positions
Following enactment of the Patient Protection and Affordable Care Act (PPACA), Boston Scientific continues to be actively engaged with respect to the implementation of a number of its provisions including comparative effectiveness research (CER) through the Patient-Centered Outcomes Research Institute (PCORI), the medical device excise tax, pilot programs of alternative payment models that are value-based, and Medicare reimbursement cuts to hospitals.
- Comparative effectiveness research (CER) is one of the key tools of "evidence-based medicine" identified by the PPACA that will be necessary to lower costs and improve quality. Boston Scientific believes that evidence-based data and information can help patients, physicians, hospitals, payers, technology developers and other stakeholders improve their decision-making. We support CER through PCORI created to conduct research on the benefits of alternative treatments and its focus on the clinical appropriateness of alternative treatments. It is critical that the CER agenda and related questions are shaped properly with input from multiple stakeholders, including medical specialty societies and medical device representatives, and that all relevant data is considered in assessing the clinical effectiveness of alternative treatments.
- Boston Scientific has long supported efforts to provide evidence to help physicians and patients make health care choices. For example, in 2005, Boston Scientific sponsored the SYNTAX study, a ground-breaking comparative clinical effectiveness study designed to determine the best treatment for complex coronary artery disease by comparing coronary artery bypass surgery and drug-eluting stents. Our clinical research has resulted in a deeper and richer understanding of the clinical and patient outcomes for patients with coronary artery disease and heart failure.
- Boston Scientific continues to sponsor clinical trials and post-market studies focusing on cardiology, cardiac rhythm management, electrophysiology, urology, women's health, neuromodulation, and other specialty areas. We also provide research grants to independent researchers and plan to continue to shape CER policies and practices through discussions with organizations such as PCORI, the Center for Medicare and Medicaid Services, the Food and Drug Administration and medical specialty societies.
The Medical Device Excise Tax
- We strongly oppose the excise tax on medical device manufacturers contained in the PPACA. We believe that the impact of the tax will be significant for Boston Scientific and will cost us up to $150 million dollars annually starting in 2013. The additional tax burden does not create a favorable climate for innovation and growth. Boston Scientific is working in coalition with the medical device trade associations, the Advanced Medical Technology Association and the Medical Device Manufacturers Association, on issues pertaining to the $30B medical device excise tax. We are also working closely with almost 70 members of the House and Senate Medical Technology Caucus, committees of jurisdiction and leadership of both chambers of Congress.
Pilot Programs for Alternative Payment Models that are Value-Based
- We believe patients should have access to the care they need and access to the latest medical technology. Implementation of healthcare reform should be accomplished without hindering and, in many cases, eliminating the development and delivery of innovative new technologies to address the clinical needs of patients.
- Medical devices should be viewed as drivers of healthcare value. Medical device access under various healthcare reform programs to improve quality and reduce costs must be preserved, and quality outcome measures should capture the long-term benefits of medical technology.
- Payment incentives under alternative payment models, such as ACOs and bundled payments, can discourage providers from using breakthrough treatments and diagnostics, particularly, if they are expected to increase the spending per patient. To ensure Medicare beneficiaries have access to innovative treatments, we believe CMS should provide appropriate adjustments to a limited number of technologies that would neither penalize nor reward participating providers. With such adjustments, potential early adopters would make decisions purely on medical grounds.
Medicare Reimbursement Cuts to Hospitals
- Boston Scientific is opposed to the Medicare reimbursement cuts to hospitals under the PPACA. We support appropriate payments to providers that cover the costs of medical technology and support programs, such as Medicare's new technology payment provisions for inpatient and outpatient hospital services, which recognize the costs of new services and technologies showing substantial clinical improvements. Appropriately designed payment systems should promote the use of treatments that offer more value in terms of outcomes such as decreased repeat procedures, fewer hospitalizations, and improved quality of life.
Boston Scientific Corporation