With effect from 22 May 2007, any doctor treating a CMS patient is entitled to claim professional reimbursement if they use oesophageal Doppler monitoring (ODM) to guide fluid delivery:

• in patients in intensive care whose breathing is assisted by a ventilator; or
• in patients undergoing surgery who require fluid management.

CMS reached its decision because it considers using ODM on these groups of patients to be both ‘reasonable and necessary’.

This is following the reversal of a pre-existing national coverage determination that specifically excluded reimbursement of esophageal Doppler when used in the CMS patient population.

CMS’s Acting Administer Leslie V. Norwalk commented: ‘(This) decision reflects CMS’ commitment to using evidence-based approaches to provide Medicare beneficiaries with reasonable and necessary medical technologies as they evolve through innovation in the marketplace. As we developed this decision, we used the best available medical evidence-in the form of randomized controlled clinical trials-to re-evaluate our position on this important non-invasive method of caring for patients in intensive care situations.’

CMS’s press release on 22 May 2007 also noted that: ‘In contrast to other techniques for measuring cardiac output, the probe of the esophageal Doppler can be inserted within minutes, requires minimal technical skill, and is not associated with major complications.’

A copy of the CMS commissioned, Health Technology Assessment supporting this decision can be viewed using the link on the right. In addition, a link to the CMS final decision memo is also available here.

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