Lawmakers challenge Medicare on catheters

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Jon Kamman
The Arizona Republic
Jul. 5, 2006 12:00 AM

With key support from a fellow Arizona congressman, U.S. Rep. Rick Renzi is heading for a showdown with Medicare over a policy that forces tens of thousands of bladder-impaired patients to reuse urinary catheters despite risks of infection.

Renzi and J.D. Hayworth, both Republicans, asked House colleagues last week to co-sign a letter urging the Medicare program, which funds health care for disabled people of any age, to pay for a sterile catheter for each use.

For at least a decade, Medicare has paid for only one catheter a week for outpatients, expecting them to reuse it 30 to 40 times.

A catheter is a narrow tube inserted by hand through the urethra to drain the bladder.

The Food and Drug Administration, which regulates medical devices, has not approved the manufacture or marketing of any reusable catheter in this country.

"We're going to get more than 218 members (a majority of the House) to sign the letter (by midmonth)," Renzi said.

"Then, we'll go to Medicare, show them the draft of a bill (requiring a change), and say, 'You've got two weeks or we're (filing) this bill and talking about how you obstructed this fix.' "

Renzi said majority support in the letter would be "a hammer" that could bring change quickly, rather than in legislation that could take a year to pass.

He took up the issue last year at the instigation of Mesa paraplegic Steve Winter, a former catheter-supply employee who said he was motivated to fight because so many catheter users were repeatedly falling ill.

Winter's own catheters are paid for through private insurance.

Hayworth's recent enlistment in the effort adds considerable clout.

In the highly committee-dependent system of lawmaking, Hayworth is one of eight GOP majority members of the Ways and Means subcommittee on health, which deals with many Medicare issues and makes judgments on funding.

"Things are really moving forward," said Winter, 44, who has been wheelchair-bound since his teenage years.

"It makes me even more determined to see this through to the end," he said.

Victims of spinal-cord injuries, multiple sclerosis and spina bifida who rely on catheters already are highly susceptible to urinary-tract infections that can cause serious complications or death, the congressional letter says, but "the added risks presented by catheter reuse are amplified."

Dr. Arjun Srinivasan, a health care official at the Centers for Disease Control and Prevention, wrote that "it would seem to be logical that this risk would be lowest when the instrument being inserted is sterile, which would be the case only for a new catheter."

Srinivasan said the Atlanta-based agency has no enforcement power but "would recommend" that catheter users heed the FDA's designation of the devices for single use only.

Medicare reimburses just under $2 a unit for people who self-catheterize.

In hospitals and care homes, the program pays for a new catheter and other sterile procedures for each use.

If catheter users were provided a sterile one for every urination, the cost would soar from about $8 a month to $325.

Medicare provides no guidance on how to clean and store a catheter between uses.

Techniques described elsewhere suggest simply rinsing it with soap and water, soaking it in bleach or microwaving it.

One objection raised in the congressmen's letter to Medicare's administrator, Dr. Mark McClellan, focuses on the criteria most patients would have to meet to qualify for a sterile catheter for each use.

"Individuals should not be required to suffer through two infections in a year before being eligible," Renzi and Hayworth wrote.

In contrast to federal Medicare policy, about half of the nation's state-run Medicaid programs pay for "significantly more" catheters than one a week, the congressmen say.

Medicare defends reuse as a cost-cutting measure justified by studies dating as far back as 35 years.

The Renzi-Hayworth letter argues, however, that treatment of urinary-tract infections is expensive and can be lessened by using only sterile catheters.

After a review of medical literature, Winter and a researcher concluded last year that, at best, there is insufficient evidence to declare reuse safe.

Studies have not compared sterile-vs.-reuse practices and in many cases were not conducted scientifically or are being misinterpreted, Winter said.

Reach the reporter at jon.kamman@arizonarepublic.com or (602) 444-4816.

The Above article is provided by: The Arizona Republic - http://www.azcentral.com/arizonarepublic/

Last Update: January 19, 2007 10:55 AM