There are several possible reasons. Let us dispense with the most obvious first, namely, that EECP doesn’t pay well. A series of 35 treatments costs $5000 to $6000 dollars. That’s not chicken feed, but keep in mind that we’re talking about 35 hours of therapy over 7 weeks, which involves not only the doctor’s time but also the time of office staff, nursing personnel, etc., etc. Still not a terrible return, but when you consider that a cardiologist can often bill that much by spending a morning in the cath lab, well - - -.
Then there’s the fact that EECP remains somewhat intellectually unsatisfying. To your average cardiologist, there’s no reason at all that anyone should have thought it would work in the first place – that temporarily providing counterpulsation would have lasting effects. And the fact that it apparently does work is merely blind luck, and leaves investigators scrambling ridiculously to explain why it does. This is a less than satisfying way to advance science.
In addition, to most cardiologists, EECP is logistically difficult. To accommodate patients for EECP, they would not only have to purchase expensive equipment, but also would have to radically change the organization of their offices, their office staff, and their space.
Finally, and most importantly, EECP has nothing in common with what cardiologists do. Cardiologists study and treat the heart, for goodness sake. They stress it, image it, measure it, pace it, shock it, stent it, ablate it, revascularize it, and bathe it in drugs. What they do takes years of specialized training and expertise, millions of dollars of high-tech equipment, and tremendous manual dexterity, and it brings them significant prestige, even within the medical community.
Now they’re supposed to drop all that? In order to attach fancy balloons to peoples’ legs, throw a switch, watch them bounce around for an hour, then say, “See you tomorrow?” That’s not cardiology. That’s glorified physical therapy.
This, in DrRich’s estimation, is the real reason the average cardiologist is completely ignoring EECP, as if it doesn’t even exist. They simply can’t believe anyone really expects them to do this.
In any case, you may need to raise your cardiologist’s consciousness. If you have coronary artery disease that has proved difficult to treat, then you need to bring EECP up yourself.
Once enough patients show themselves to be aware of this new therapy and to be expecting it, suddenly EECP will no longer be beneath cardiologists, and they’ll eagerly find a way to incorporate it into their practices.
How can you receive EECP?
If you are a candidate for EECP and wish to pursue it, start with your doctor. If your doctor discourages you from pursuing EECP, make sure he/she gives you a good reason for discouraging it. Good reasons would include: you don’t have the sort of coronary artery disease or angina that would benefit from EECP; your coronary artery disease is of the type that requires revascularization; or you have one of the contraindications (listed above) for having EECP. (Good reasons would not include: it’s unproven; it doesn’t work; it’s voodoo; or I’ve never heard of it.)There are fewer than 200 places today performing EECP, though the number is growing rapidly. If your doctor can’t think of a place to refer you for EECP, go online. The best place to start online would be EECP.com. This is a website run by Vasomedical, Inc., the company that makes the equipment for EECP, so it is not unbiased. But it does offer an excellent means of finding a place where you can get EECP in your area.
Your insurance carrier should cover EECP, though these fine humanitarians might well deny coverage initially. Medicare has approved EECP for reimbursement, and once Medicare approves a new treatment, insurance companies normally fall in line quite quickly. In the case of EECP, however, many insurance companies are still balking at paying, perhaps because their cardiology consultants are telling them it’s not really a serious therapy. Don’t let this discourage you. If you are turned down for reimbursement, appeal the decision. Most insurance companies count on patients failing to appeal (which is why they so frequently deny therapy that is obviously needed), and with Medicare supporting your contention that EECP ought to be covered, odds are that if you appeal you’ll win.
