From: CM Luetje MD [cmluetje@comcast.net]

Sent: Monday, April 11, 2011 3:31 PM

To: CMS MedCACPresentations

Cc: Pete Weber

Subject: Atteion Maria Ellis: MedCAC Panel Comment Cochlear Implants for Sensorineural Hearing Loss/May 11, 2011

Dear Ms Ellis:

I am writing this email on behalf of the many patients I have implanted with cochlear implants (CI), beginning in 1979. It has been my privilege and honor to have patients trust their hearing restoration to me through CI and have been involved in the technical evolution from sound awareness to speech understanding from the devices. I started the Midwest Ear Institute in Kansas City, MO in 1980 for that purpose. We are approachng our 1000th CI sometime this year.

While there is an abundance of scientific literature to support CI in Medicare beneficiaries, I simply wish to give an opinion based upon my own experience. I have long been in pursuit of implanting patients with better hearing than earlier criteria as set forth by Medicare, not only unilateral but bilateral when indicated. It is extremely difficult to put a percentage score as a single criteria to implant. However, we all understand there must be some guidelines. Certainly, patients with "test scores" in the 50-60% range have benefited from implantation. The ability to provide more with a CI than by pounding sound against the ear drum with a hearing aid is well known to all of us who do CIs.

I urge the Panel realize hearing in two ears is better than one and either simultaneous or sequential unilateral CI surgery is superior. Further, I urge them to allow implantation criteria to expand to >50% and <60% test scores. There are many individuals I have had to look straight in the eye and say, "Based on Medicare criteria, you are not a candidate. I know you would benefit from a cochlear implant but Medicare will not pay for it." They do not have the financial means to do it. This really hurts because that individual is missing the newer technology which would give them QUALITY OF LIFE.

Thank you for reading this and I hope the Panel will get to see my "unscientific" opinion.

Charles M. Luetje, MD, FACS