Changes In Doctors' Reimbursement Has Not Affected Access To Cancer Care
Main Category: Medicare / Medicaid / SCHIPAlso Included In: Cancer / Oncology
Article Date: 09 Jul 2008 - 4:00 PDT
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The Medicare Modernization Act of 2003, which reduced the amount of money doctors are reimbursed for the delivery of chemotherapy treatments, has not harmed patients' access to care in the way critics feared it might, according to a new study, led by investigators from the Duke Clinical Research Institute (DCRI). Researchers measured patient access to care by looking at the distance they traveled to be treated and the time that lapsed between diagnosis and initiation of chemotherapy.
"The Medicare Modernization Act took issue with the fact that oncologists were often reimbursed too much -- sometimes as much as three times what they had paid -- for the chemotherapy drugs they were giving their patients, and subsequently doctors saw those reimbursement payments fall," said Kevin Schulman, M.D., director of the DCRI's Center for Clinical and Genetic Economics, and senior investigator on this study. "The concern was that patient care would suffer if doctors had to close their practices or scale back, making it necessary for patients to travel farther or go to inpatient facilities for treatment. Our study showed that this, in fact, has not yet occurred."
The findings were published in the July 9, 2008 issue of the Journal of the American Medical Association. The study was funded by a grant from the National Patient Advocate Foundation's Global Access Project, which brings together 42 national healthcare stakeholder groups -- such as pharmaceutical companies and advocacy groups -- to fund health research projects. The Project has focused on examining the Medicare Modernization Act's consequences for patients, providers and healthcare systems.
Duke researchers studied data about Medicare beneficiaries who received chemotherapy for diagnoses of leukemia, lymphoma, breast, lung or colorectal cancer from across the United States. They looked at the distance patients traveled to get their chemotherapy treatments, and the amount of time that lapsed from diagnosis to initiation of chemotherapy. They compared data from 2003, before the Medicare Modernization Act took effect, to the data from subsequent years through 2006.
"The distance patients traveled for chemotherapy treatments did not considerably increase after passage of the act," said Lesley Curtis, Ph.D., a health services researcher in the DCRI and lead investigator on this study. "And despite concerns that patients would have to go to inpatient settings with longer wait times to be treated, we observed a small shift in the provision of initial chemotherapy from inpatient to outpatient settings between 2003 and 2006."
According to Curtis, the median amount of time patients waited to begin chemotherapy after diagnosis was 28 days and did not change significantly for any of the treatment settings between 2003 and 2006.
It is possible that the long-term effects of lower reimbursement have simply not been seen yet, Curtis said, but for now, it looks like the fears of the act's critics have not been realized and that patients are not being adversely affected by the implications of this legislation.
"We did find that patients in rural areas tended to have to wait longer to begin their chemotherapy after diagnosis -- their wait times increased by up to five days from 2003 to 2006," Curtis said. "Whether this is something that could have a negative effect on treatment outcomes is still unknown, but it is something we should continue to follow."
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Other researchers involved with this study include Alisa Shea, Bradley Hammill, Lisa DiMartino and Amy Abernethy.
Source: Michelle Gailiun
Duke University Medical Center
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Medicare Modernization Act Did Not Change Chemotherapy As Feared
posted by Gregory D. Pawelski on 9 Jul 2008 at 2:23 pmGranted, the new Medicare D program was filled with lots of holes. The biggest problem was in designing the program. This administration did not want the Medicare drug benefit to be administered directly by the federal government (where Medicare is run efficiently). Instead, it devised a public program run by hundreds of competing private plans, each with its own prices and coverage policies.
Also, a joint Michigan/Harvard study confirmed, before the new Medicare reform, medical oncologists were more likely to choose cancer drugs that earn them more money. Yet a survey published in "Patterns of Care" showed that the Medicare reforms have not solved the problem of variations in oncology practice.
http://www.healthyskepticism.org/news/2007/Jun.php
However, the new Medicare drug benefit plan was part of a much broader message. With oncology drugs accounting for about 69% of total Part B spending on prescription drugs and related services, the new Medicare D plan made it more important for Senior cancer patients.
A study published in the journal Health Affairs discovered that Part D expanded access to cancer therapies and required only low co-payments. Researchers found that the most commonly prescribed cancer drugs were available and when a brand-name drug was not covered, its generic equivalent was.
Apparently Medicare has gone far in accomplishing the task of making many cancer drugs available to our Seniors. Nearly all generic cancer drugs and 70% of brand-name cancer drugs are covered by the Part D plans. Most of the brand-name drugs not covered had generic equivalents that are covered. Also, a number of trusted old generic agents have been found to be just as effacious as the more expensive brand name ones.
According to NCI's official cancer information website on "state of the art" chemotherapy, no data support the superiority of any particular regimen. So, it would appear that published reports of clinical trials provide precious little in the way of guidance. There are many cancer drug regimens, all of which have approximately the same probability of working. The tumors of different patients have different responses to chemotherapy.
Medical oncologists are now be reimbursed for providing evaluation and management services, making referrals for diagnostic testing, radiaiton therapy, surgery and other procedures as necessary, and offer any other support needed to reduce patient morbidity and extend patient survival. In other words, medical oncologists were taken out of the retail pharmacy business. However, as Medicare tried to do this, private insurance plans still go along with the chemotherapy concession.
According to an article published in the New England Journal of Medicine, an unintended effect of the Medicare Part D benefit could be the creation of the world's most valuable resource for understanding how drugs are used, especially by the elderly and the chronically ill, and their risks and benefits.
http://content.nejm.org/cgi/content/full/353/26/2742
Now, if only Medicare would be allowed to negotiate prices, eliminate the doughnut hole, and stop subsidizing private insurance Medicare Advantage plans!
For five years now, Medicare has been paying private Medicare Advantage plans much more per enrollee compared with what the same enrollees would have cost in the traditional Medicare fee-for-service program.
It's time for the Congress to examine whether the extra payments to Medicare Advantage plans are the best use of tax-payers dollars for the beneficiaries the program is designed to serve.
These payments could be used to provide better benefits, like filling in the doughnut hole and reduce out-of-pocket costs for seniors and the disabled, as well as to create a viable alternative to the ineffective sustainable growth rate mechanism currently used to determine the physician payment update.
Traditional Medicare needs to be able to compete on a level playing field with private plans, which requires the elimination of these extra payments.
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