SAAAVE Passes, But Screening Only The Beginning

BY NELLIE BRISTOL

Impending Medicare coverage of screening for abdominal aortic aneurysm, although welcomed by vascular surgeons, is only the first step in the process of ensuring maximum benefit from the service, according to Dr. Robert Zwolak, National Aneurysm Alliance chair, and member of the Society for Vascular Surgery board of directors.

The Screening Abdominal Aortic Aneurysms Very Efficiently Act (SAAVE), signed into law Feb. 8 by President Bush as part of the Deficit Reduction Act, will provide one-time abdominal aortic aneurysm (AAA) screening for males who have ever smoked and for males or females who have a family history of the disease. Screening will be provided as part of the Welcome to Medicare physical and will be covered starting Jan. 1, 2007.

Funding for educational campaigns and requirements for quality standards were stripped from the final bill. The final provision also is less broad than supporters had hoped for in that it is likely to be limited to Part B beneficiaries who enroll after the start date, Dr. Zwolak said.

He noted that Medicare beneficiaries sometimes do not take advantage of covered preventive services; therefore, vascular surgeons will need to work to ensure that the benefit is used.

"Hopefully we can diffuse the education to patients and primary care providers about aortic aneurysm--because it's not the most well known disorder--and also we need to diffuse the education that the screening benefit will be available starting Jan. 1, 2007," he said. "A comprehensive educational effort would cost millions and millions of dollars, so we're going to have to rely on foundations and public service messages and so forth to get this news out."

Screening proponents hope to expand the benefit in the coming years. The original legislation would have provided screening not only to Medicare beneficiaries with a family history of AAA, but also to those who are at risk for cardiovascular disease or atherosclerotic vascular disease.

"The sponsors of the bill were hopeful that we could provide this benefit to everyone at risk the very first year" without linking screening to the Welcome to Medicare physical, Dr. Zwolak said. But "it was too expensive in a deficit year to do that. We felt that it was reasonable to phase this in on an annual basis at least."

Screening supporters also hope over time to amass the data needed to argue for expansion of the benefit to other populations, including female smokers. "Some of us believe that they should be on that list as well, but we need more data to help that," he said.

Last year, the U.S. Preventive Services Task Force recommended one-time screening for AAA by ultrasonography in men aged 65-75 years who have ever smoked. In arguing for its broad availability, Dr. Zwolak said, "There is a very effective treatment for the disease. If left untreated [it] has a very high mortality. There is a superb screening test that is inexpensive and accurate."

Screening for and treatment of diagnosed AAAs is estimated to cost $200 million over 5 years, according to the Congressional Budget Office. The CBO estimates that 58,000 beneficiaries will be screened the first year.

"The NAA is a coalition of medical professional organizations, foundations, patient advocates, and medical technology manufacturers dedicated to reducing the number of Americans who die needlessly each year from ruptured aortic aneurysms," Dr. Zwolak said. The organization was key to bringing AAA screening to the attention of Congress.

SVS is the founding member of the NAA, with supporting organizations including: American College of Surgeons, American Registry for Diagnostic Medical Sonography, American Society of Echocardiography, American Vascular Association, Aneurysm Outreach, Inc., New England Society for Vascular Surgery, Society for Diagnostic Medical Sonography, Society for Interventional Radiology, Society for Vascular Medicine and Biology, Society for Vascular Ultrasound, Southern Association for Vascular Surgery, and the Vascular Disease Foundation.