In Brief

Medicare will institute a national policy for coverage of the biofeedback technique for urinary incontinence before April 2001, the Health Care Financing Administration (HCFA) announced recently.

The technique was developed by psychologists in conjunction with physicians in the early 1970s, according to the Association for Applied Psychophysiology and Biofeedback (AAPB). It has been used by psychologists, doctors, nurses, physical therapists and other health professionals for many years. However, because Medicare's national policy does not specifically address biofeedback's use for urinary incontinence, the decisions on whether to reimburse for it have been left to the discretion of the Medicare "contractors," the insurance companies that handle Medicare claims.

John D. Perry, PhD, chair of the AAPB Task Force on Incontinence, says psychologists and other health professionals have had problems obtaining reimbursement for the technique from some of the contractors.

In addition, says AAPB President Doil Montgomery, PhD, because private insurers often follow Medicare's lead in coverage policies, most have not offered reimbursement or have covered the procedure only after several other procedures--sometimes including surgery--have been tried.

An encouraging aspect of HCFA's decision, says Perry, was the collaboration of a variety of health professions that brought it about. The Medicare Coverage Advisory Panel, which considers coverage issues for HCFA, had said that the research literature did not contain adequate evidence for the technique's effectiveness. However, groups representing psychologists, physicians and others testified before the panel on the technique's usefulness, influencing the decision.

Urinary incontinence is a widespread and expensive problem, affecting an estimated 13 million adults and causing serious reduction in quality of life. It costs an estimated $15 billion a year and is cited as one of the major factors in causing older adults to be placed in nursing homes. Montgomery says that most people with the problem don't seek help because they are embarrassed or they may think nothing--or nothing short of surgery--can be done.

Pelvic floor muscle exercise is a first-line and an effective treatment for the problem, but it is difficult for some patients to learn to do the exercises correctly. That's where the biofeedback technique comes in. Done with sensors placed in the vagina or anal canal, it helps the patients know when the muscles are contracted properly. It can usually solve the problem in a few sessions, according to Montgomery.

Material on the converage decision is on the HCFA Web site at: http://www.hcfa.gov/quality/8b3-x.htm.