Olympus has announced its support for a decision by the Centers for Medicare and Medicaid Services (CMS) to significantly increase the payment rate for the per-oral endoscopic myotomy (POEM) procedure, a change that is expected to improve patient access to the minimally invasive procedure.
Effective Jan. 1, CMS increased the hospital outpatient payment rate for POEM procedures, CPT code 43497, by 67% from approximately $3,261 to $5,435. The higher payment rate is reflective of the complexity and resources of this time-intensive procedure.
“Following a rigorous evidence-based review by CMS, we are very pleased to see this positive payment update for the POEM procedure,” said Paul Skodny, PharmD, Executive Director for Health Economics and Market Access at Olympus Corporation of the Americas. “As we continue to advocate for improved access to minimally invasive procedures like POEM, this type of positive decision is an important development and one that aligns with our core values that include patient focus.”
POEM is a minimally invasive procedure performed endoluminally as an alternative to open or laparoscopic surgery and is used to treat swallowing disorders such as achalasia. Achalasia is an esophageal disorder in which the lower esophageal sphincter does not relax properly, preventing food and liquid from moving into the stomach.
POEM is an alternative to the laparoscopic surgical option of Heller’s myotomy for the treatment of achalasia. A common nonsurgical treatment option is pneumatic dilation in which a ballon is inserted into the esophageal sphincter and inflated to enlarge the opening. The procedure may be repeated if the esophageal sphincter does not stay open, and about a third of people who undergo this procedure need treatment again within five years.1
Studies looking at the effectiveness of POEM found that the procedure is safe and effective with 90% clinical success at more than five years and that POEM demonstrated significantly greater clinical success at 12, 24 and 36 months compared to pneumatic dilation.2, 3
“We applaud CMS for the decision to bring the payment rate for POEM into better alignment with the complexity of the procedure. We hope this results in greater patient access to a procedure that offers the potential for improved patient outcomes,” said Craig Munroe, MD, Global Lead Medical Affairs GI-ET. “Olympus is a pioneer of endoluminal procedures and has worked with GI societies and stakeholders to advance minimally invasive procedures such as POEM. As part of our commitment to patient focus, we will continue working to raise awareness around options such as this.”
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