Cost and reimbursement rates for investigational circulatory support

The clinical evaluation of investigational circulatory support devices has, for the most part, been financed with private funds. St. Louis University initiated a system in 1986 to bill for investigational circulatory support devices and care related to their use. Charges for hospitalization and rates of reimbursement were reviewed in 32 patients who received Thoratec (Thoratec Laboratories Corp., Berkeley, CA [N = 26]), Novacor (Baxter Healthcare Corp., Oakland, CA [N = 4]), or Symbion (Symbion Inc., Tempe, AZ [N = 2]) total artificial heart devices. Duration of support ranged from 0.2 to 440 days (mean 32). Total charges ranged from $43,115 to $1,335,691 (mean $221,716). Charges for the devices and technical support relating directly to their use ranged from $10,305 to $96,030 (mean $28,246). The mean percentage of reimbursement (total charges/total paid) was 67%. Whereas it was uncertain in some patients whether or not the devices were paid for, commercial insurers are willing to reimburse at a high percentage for the total cost of care.