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The U.S. Centers for Medicare & Medicaid Services (CMS) has announced that Medicare will begin paying for lung volume reduction surgery (LVRS) for certain people 65 and over who have severe emphysema with specific traits that make them likely to benefit from the surgery. As part of this decision, CMS named Columbia University Medical Center at NewYork-Presbyterian Hospital as a center of excellence—one of a select number of hospitals granted coverage for the procedure. Medicare approval followed the positive results of the National Emphysema Treatment Trial (NETT); Columbia University Medical Center was the only New York City-area center selected to participate in the study.

Following the NETT findings, Medicare will cover the procedure for two groups of patients: those who have severe emphysema in the upper lobes of their lungs, and those who have severe disease elsewhere in the lungs and a poor ability to exercise. Medicare will also require that patients be further screened through testing and extensive exercise and education programs to improve lung function both before and after surgery. Lung volume reduction surgery involves cutting away diseased parts of the lungs to help the remaining healthy tissue better function.

"Because private insurers and state Medicaid programs generally follow Medicare's example, this is good news for the more than 10,000 Americans that it's estimated could qualify for the surgery," said Dr. Byron Thomashow, clinical professor of medicine at Columbia University College of Physicians & Surgeons; medical director for the Jo-Ann LeBuhn Center for Chest Disease and Respiratory Failure at Columbia University Medical Center at NewYork-Presbyterian Hospital; and co-principal investigator for the NETT study site.

"LVRS represents the first major treatment advance for emphysema patients in almost 25 years. We are very happy that it will now be available to most everyone who needs it," said Dr. Mark Ginsburg, assistant clinical professor of surgery at Columbia University College of Physicians & Surgeons; associate director of general thoracic surgery and surgical director for the Jo-Ann LeBuhn Center for Chest Disease and Respiratory Failure; and co-principal investigator for the study. "We are proud to have contributed towards a greater understanding of the LVRS, and now, towards its greater availability."

Emphysema is a progressive, chronic, and disabling lung condition that affects primarily individuals over age 50 who are current or former cigarette smokers. With emphysema, breathing becomes difficult as the fine architecture of the lung is destroyed, leading to large holes in the lung, obstructed airways, trapping of air, and difficulty exchanging oxygen because of reduced elasticity of the lungs. Emphysema costs more than $2.5 billion in annual health care expenses and causes or contributes to 100,000 deaths in the U.S. each year.

The NETT study showed that patients with severe emphysema who undergo LVRS on average do not face an increased risk of death, and are more likely to function better compared to those who receive only non-surgical treatment. The study also identified specific criteria to determine which patients will benefit from the procedure. The five-year randomized study represents an unprecedented collaboration between the National Institutes of Health (NIH) and Medicare, and was the combined effort of 17 clinical research sites, including Columbia Presbyterian Medical Center at NewYork-Presbyterian Hospital.

The NETT study found that patients whose emphysema was mostly located in the upper lobes of the lung and whose exercise capacity was low after pulmonary rehabilitation but prior to surgery were more likely to survive longer and function better after LVRS compared to similar patients who solely received standard treatment. In contrast, in patients who did not have upper lobe distribution of emphysema and who had greater exercise capacity, LVRS decreased survival and failed to improve functional levels.

In LVRS, 25 to 30 percent of the most damaged regions of each lung are surgically removed. Scientists believe that by surgically removing functionally useless tissue, air will move in and out of the remaining lung more readily, thereby easing symptoms associated with advanced emphysema and improving overall lung function. LVRS was widely performed from 1993 until 1995, at which time Medicare halted coverage of the procedure, citing concerns over risk for morbidity; many other insurance carriers followed suit. The operation costs about $60,000.