Expanding access to health care matters

Revolutionary advancements in technology mean that most things in our lives have become quicker, easier or more effective. I am fortunate to have seen this revolution in my lifetime.

Consider travel. What used to be a day-long cross-country adventure via car has become a half-day commute with the possibility of starting your morning in San Francisco and ending in New York in time for an early dinner — a trip I’ve made countless times.

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Much of our daily lives have improved thanks to purposeful and thoughtful innovation, including, health care.

One of the fields in medicine that has seen some of the most incredible innovation is cardiovascular medicine. For decades, one of the standard treatments for someone suffering from a heart valve condition was open-heart surgery to replace the malfunctioning valve, a difficult and challenging procedure under any circumstances. The good news is that just as baby boomers move into a period of their lives in which age-related ailments like heart disease become more prevalent, science has helped advance treatment options.

These innovations are important because heart valve disease affects up to 11 million Americans and costs at least $23.4 billion annually.

Thinking of a heart valve like a gate, problems arise when it fails to open and close properly. Symptoms start to occur and as that gate becomes even harder to budge, the symptoms such as fatigue, chest pain, shortness of breath, even an inability to engage in the simplest of activities — worsened to the point that there is great risk of dying.

As the condition worsens, if chalked up to old age instead of treatable heart valve disease, once active and relatively healthy people are robbed of their independence, increasingly making trips to the doctor.

But like other advances in science and medicine, we now have more options that not only resolve this deadly heart condition, but also provide an easier and more efficient treatment. Called transcatheter aortic valve replacement (TAVR), this procedure uses a catheter, or tube, inserted into a patient’s leg to deliver a life-saving valve into the heart while it continues to beat. No more cracking open the chest and surgically implanting a valve. This means some patients can return home the day after having their valve replaced, instead of spending days in a hospital and weeks of grueling rehabilitation.

TAVR has been around for nearly a decade and the results show us that patients are realizing great success with lower mortality and strokes post procedure and shorter stays in the hospital at less overall cost to our health care system.

As with many breakthrough medical technologies, TAVR was initially introduced at a limited number of hospitals, under policy that tightly governed which doctors could utilize it. This made sense at the time and while well-intentioned and, importantly aligned with the medical community’s goal of ensuring excellent patient outcomes, there is a consequence of the coverage policy being left in place for so long — restrictions on access. For example, someone living in Wyoming would need to travel out of state to get to a hospital that offers TAVR. Adding additional hurdles to treatment while contending with the burden of a progressive disease is not our government at its best.

But there is a way to address this situation. The Centers for Medicare and Medicaid Services (CMS), which I oversaw when I was Secretary of Health and Human Services (HHS), is the agency that administers the health care policies that affect older Americans and has a process to determine how new technologies like this are covered. It’s called a National Coverage Decision (NCD) and CMS periodically updates these NCDs, which it is currently doing for the TAVR heart value technology.  

Given what we know about TAVR, CMS could ensure that patients who need TAVR can readily access it with doctors or hospitals they know and trust. And while CMS is conducting a thorough review of the available data, patient experience and physician perspective on this therapy, it is also faced with the challenge of responding to voices that call for further restrictions and limited access to a safe and effective therapy.

For me, the most rewarding part of being HHS Secretary was knowing that our actions had an impact on all Americans and so when we knew something worked, we acted to make sure all Americans who needed it had access to that advancement. This is exactly what is at stake with the TAVR heart valve.

We now know it is effective, but only certain Americans can have access to it based on where they live. Limiting the doctors and hospitals who can use TAVR to only those who meet restrictive criteria would be akin to only allowing only those who can get to large regional hubs to fly cross-country, leaving the rest to drive.

Tommy G. Thompson was the 42nd Governor of Wisconsin (1987-2001) and  the 19th Secretary of the Department of Health and Human Services for President George W. Bush. He is the chairman and chief executive officer of Thompson Holdings.