Cost-Effectiveness Policy In Brief

CMS coverage chief calls for cost consideration: The Medicare agency does not consider the cost of an item during the coverage process, but "we should," says Steve Phurrough, director of the coverage and analysis group in the CMS Office of Clinical Standards and Quality. Speaking Dec. 3 at a conference on value-based purchasing led by the ECRI Institute, Phurrough says that the high cost of a device might lead the coverage team to consider the technology for a potential national coverage determination, but CMS does not evaluate cost in the national coverage process. The policy may change in the future, but the agency will wait to "see what happens in the months ahead, as Congress and the new administration give us whatever guidance they're going to give us." Phurrough and other leaders from government, industry, medicine and academia met for the two-day conference in Washington, D.C., to address the role of comparative effectiveness, cost effectiveness and pay-for-performance in health reform. Recently, CMS asked its Medicare Evidence Development and Coverage Advisory Committee to consider cost as part of a national coverage determination process for computed tomography colonoscopy (1"The Gray Sheet" Nov. 3, 2008, p. 10)