STATE LEGISLATIVE PACKET (4) BOB WEISS
Letter to State Legislator
I am a New York resident who was diagnosed and treated for breast cancer a few years ago. Unlike the majority of breast cancer survivors I happen to be male. But like a large percentage of breast cancer survivors, I suffer from a chronic, incurable condition resulting from my cancer treatment—lymphedema. ***Substitute your own details***
Unfortunately, U.S. physicians and health care personnel are woefully unaware of the extent of this condition, and the protocols of its medical treatment. Medicare and other health care insurers rarely cover the medical protocols practiced in Europe for over thirty years, and recommended here in the U.S. in 1998.
I would like to propose that you sponsor urgently needed changes to current legislation as well as suggestions for new legislation to treat lymphedema. (Please see the attached suggested legislative priorities). This is not a new health care mandate that needs new funding. Rather, it is a protocol that can utilize in-place medical personnel and has been shown to be at least cost-neutral, and at best can save hundreds of millions of dollars in unnecessary treatment of avoidable infections, avoidable pain and avoidable disability and deformity.
The General Assembly of Virginia has recently passed legislation for lymphedema treatment (VA H.B. 1737 Wardrup) which was deemed to have no fiscal or budgetary impact by the Virginia Department of Corporations. The Massachusetts Senate is considering a bill (MA S.B. 848 Fargo) which will provide coverage for lymphedema treatments.
Some of these suggestions are simple, such as the fixing of a three-year old WHCRA that is clearly faulty, or enacting conforming legislation in New York. Some are suggestions that might help CMS to do their job in a professional manner. Others are suggestions for an epidemiology study, a necessary cost-effectiveness study, simple changes to the SSA to enable compliance with the WHCRA of 1998, and suggestions for new State and Federal laws to help the millions of lymphedema sufferers and SAVE MONEY in the process.
I feel strongly that many breast cancer survivors who suffer from lymphedema have not benefited from the Women's Health and Cancer Rights Act of 1998 because CMS has not seen fit to properly implement the lymphedema treatment provision according to current standards of medical treatment. Nor have the errors in wording of that three-year old Act been corrected to apply the lymphedema provisions to men, and to men and women who have not chosen reconstructive surgery. These technical corrections should be easily fixable
as a first step in any lymphedema legislative program.
There is an important fiscal aspect to this problem:
Millions of dollars are being spent unnecessarily by medical providers to treat cellulitis and lymphangitis resulting indirectly from denials by Medicare of the preventive treatment modalities accepted by NIH NCI, ACS, ISL, NLN, LRF and most other knowledgeable medical and therapeutic organizations;
Millions of dollars are being spent unnecessarily in needless appeals of Medicare denials around the country--many of which are being reversed by Administrative Law Judges who recognize that the current standard of lymphedema care includes CDT.
Millions of dollars are being wasted because the expensive Medicare-approved pneumatic pumps are ending up unused by patients who find that they don't help or have caused further bodily damage--and these same patients are discouraged from seeking the treatment that is most likely to help them because there is no coverage of this treatment.
If you decide to pursue this matter I will put you in touch with the lymphedema treatment advocate Robert Weiss who wrote the proposal and who can provide back-up to the attached legislative proposal. Thank you for your assistance in this matter.
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Page Updated: Dec. 17, 2011