new medicare guidelines

I am frustrated about Medicare’s new guidelines, that apparently your pacemaker must be in end of life mode before it can be changed.  My father is 100 percent dependent on his pacemaker and he was due to have it replaced after 6 years.  So, it’s now 6 yrs old and the doctor had him come in to get things set up for the procedure last week, the nurse saw him and stated they wouldn’t be changing it until it went into EOL mode, we then asked how we would know when that happened, she stated he would probably pass out and feel terrible but that Medicare’s new guidelines state that his pulse has to remain below 65 while active {going up stairs, etc.} for several days before they  {medicare} will pay, his secondary insurance is AARP.  Does this make sense to anyone?  Can you even be active with a pulse below 65? He also has chronic anemia so if he passes out while active it will probably kill him. Any suggestions?

11 Comments

Make Sense???

by donr - 2011-02-21 08:02:13

Of course not! It's Medicare. Very little they do makes much sense. And it's going to get worse.

The real question is "Has the PM battery dropped into that stage just before its EOL stage?" Probably when it drops into that stage (ERI) & it's going to take frequent monitoring to catch that, his Dr. can then prevail upon Medicare to replace it since he is 100% dependent.

Mine dropped suddenly & unexpectedly into EOL a few days before we were to set a date for replacement. My HR dropped to the default 65 & I continued to function - very poorly, but I functioned. Your Dad may not function that well. You are going to haver to watch him & check his pulse frequently & especially if he acts unusual or foggy.

The best to your Dad.

Don

Saw this coming

by rvrs7081 - 2011-02-21 08:02:24

I knew this was on the way. but this is a large group and there are many who do not belong to this group who have devices. Look what the tea party did. I would get a copy of those guidelines and check them out. Has he tried to do the steps they insist? I know I will be talking to my cardiologist now. Please keep us all informed and hope it works out. we are all in the same boat.

Not All True

by SMITTY - 2011-02-21 08:02:34

Hello Kcgg,

I can't speak about the Medicare new guidelines beause I have heard of that rule. But that nurse saying "he would probably pass out, feel terrible" has to be the most insensitive thing I have ever heard a so called nurse tell anyone.

But before I say more about her stupidity (I hope you can show her exactly what I have to say about her), first things first. True enough your dad will probably feel bad but the probability of his passing out is very slim. I'm not quite as old as your dad (I'll be 82 in May) but I depend on my PM more than 92% of the time. I had one to go into EOL mode in 2009 and I knew it at once. Yes, I felt bad and I knew my heart rate was not what it should be, but I never came close to passing out.

What will happen is the pacemaker will shift into a battery power conservation mode to make it last at least another three months. When this happens the PM will pace the heart at slower but at a constant rate. That rate may be anything from 60 to 70, depending on the make and model of PM. My PM had been keeping my heart rate at 80 BPM before the EOL mode and that much of a reduction did make me feel bad, but I could still navigate enough to make it with no problem until I could get it replaced.

As for being told he would need a new battery when the present one is 6 years old, well that may be a figment of somebody's imagination. A pacemaker battery life, just like the battery in your car, cannot be predicted so precisely. The normal life of one is reported to be from 5 to 7 years, but mine lasted 9 years.

So, if I can offer one suggestion it is do not worry about that battery putting your dad down unexpectedly. If you can get your dad to another cardiologist and away from that crack pot nurse, that would probably be a good ideas.

I wish your dad the best,

i agree crack pot nurse

by jessie - 2011-02-21 11:02:54

what kind of a know nothing nurse would say a thing like that to a patient. she should be reported to the college of nurses in your state, that is absolutely uncalled for and tactless. i remember my graduation and it was an ethical thing were you signed to first do no harm. that was only part of it but would cover it. jessie

thank you all

by kcgg - 2011-02-22 01:02:17

Thanks to all for your information ,I'm still not quite sure what to do next,but will surley get some kind of written statement from the cardiologist,because of his chronic anemia he has had to recently stop his blood thiner and because he has a fib [thus the pacemaker] he is at higher risk of having a stroke, especially if the battery goes into eol mode,so I know he is at high risk if he doesn't get this resolved soon. He also is on epo injections for the anemia,the hospital presented him with a $45,000 dollar bill last week saying that they just found out that medicare no longer covers his epo injections,but they wouldn't make him liable for the $45 thousand since no one knew they had stoped covering them but in the future he would have to pay $5,002.02 per injection,OK, who can afford that!!!Yes we have big problems with medicare in our future we are just beginning to see that.thanks again ,Judy

such great help

by rvrs7081 - 2011-02-22 05:02:28

from all of you. Thanks for that information, even if it was for Judy. It helps me. Does anyone know where we can get the rules of the new medicare?

Medicare Payment

by SMITTY - 2011-02-22 07:02:06


Hi RVRS7081,

There is no quick and easy way to get an answer to your question. However, you can start here www.medicare.gov. At the top of the page next to SEARCH put in PACEMAKER REPLACEMENT.

Be prepared to spend some time looking as like all
government agencies it is not simple to get the answer you need.

Another option is to write:

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore MD 21244-1850

Or you can try calling:

1-800-MEDICARE

Whichever you choose to try, be prepared to spend sometime looking as like all government agencies it is not simple to get the answer you need.

Personally, if I had a question about Medicare payment for a replacement pacemaker I would try Patient Services at the hospital where the surgery would be performed. The last place I would ask is the doctor's office.

Good luck,

Smitty

thanks Smitty

by kcgg - 2011-02-22 08:02:58

thanks for the contact info,gets me a step closer.much appreciated,so happy I've found this group.Judy

Battery Depletion

by ElectricFrank - 2011-02-22 12:02:14

Battery life can vary widely depending on the number and kind of functions that are in use. A statement of 5-7 yrs is only an estimate. The only reasonable way to determine battery condition is the interrogation report which continue to update the estimate of condition as the battery is used up.

So ask (or demand) a copy of the last checkup report. On it (near the top of the front page) will be a statement something like Estimated Remaining Battery Life. Even at 6 years you may find there is another year or more left.

Do not trust the statements of a nurse who may not know the real situation. If you are concerned that the decision is being made on the basis of Medicare rather than good medicine, ask for a written/signed statement by the responsible doctor before jumping to conclusions.

My pacer was replaced in January 2011 before it reached the End of Life indicator. There was no problem having it paid for by Medicare.

By the way the statement about "his pulse has to remain below 65 while active{going up stairs etc." is pure garbage. There is no way even a restrictive guideline would use that kind of language.

good luck,

frank

I called Medicare's 800 # today

by janetinak - 2011-02-23 01:02:11

spoke with a rep & she looked at the info she had & said she could find no new regulations about relacement. As I see my Cardio office Thursday & am on monthly checks I will ask the question & let you know what I am told. Seems that the nurse who gave out the info is the same one (if she is an RN or ???) who said Medicare had changed its rules. So I question the source. But as I will be affected soon myself I am going to keep asking questions. I did search Google & the Medicare.gov site & again saw nothing new.

Janet

Doctor's discretion

by jeroling - 2013-09-04 05:09:10

In our Device Clinic, our EP replaces pacemakers frequently before they go to ERI.

Most devices give Voltage &/or estimated time to replacement and if we feel the patient will experience symptoms at ERI, we will try to time the replacement to just prior to ERI.

We do have some patients that would be asymptomatic at ERI so we often wait for those.

As long as the physician has a reasonable indication, it is left to his discretion.

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