Medicare Costs Soar for Cancer Care

[News]

Expenditures will continue to rise as the population ages, expertssay

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[gdpawel]

Chemotherapy patients have not lost access to care despite federal legislation that has reduced reimbursements to their doctors in recent years, a new report finds.

Critics feared the passing of the Medicare Modernization Act of 2003 would make treatment more difficult, but investigators from the Duke Clinical Research Institute (DCRI) found little difference in the distance chemo patients traveled to be treated and the time between diagnosis and start of treatment.

"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," senior study investigator Dr. Kevin Schulman, director of the DCRI's Center for Clinical and Genetic Economics, said in a prepared statement. "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 researchers studied the treatment of people with leukemia, lymphoma, breast, lung or colorectal cancer from across the United States from 2003, before the act passed, through 2006.

"The distance patients traveled for chemotherapy treatments did not considerably increase after passage of the act," lead investigator Lesley Curtis, a health services researcher in the DCRI, said in a prepared statement. "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."

The median amount of time between diagnosis and chemotherapy was 28 days and did not change significantly, regardless of the treatment settings between 2003 and 2006, Curtis said.

"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."

The findings were published in the July 9 issue of theJournal of the American Medical Association.

The lower reimbursement may still have long-term effects that have yet to be realized, Curtis cautioned.

SOURCE: Duke University Medical Center, news release, July 8, 2008

[gdpawel]

Granted, 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 plans!

[gdpawel]

In a rare bit of good news for taxpayers, the cost of the Medicare prescription drug program fell $6 billion this year — savings driven by the widespread use of low-cost generic drugs.

The prescription drug program for seniors has cost about one-third less — about $50 billion — than originally estimated since it started in January 2006.

http://www.usatoday.com/news/health/...terstitialskip

It's been difficult for the Medicare program to contol the substantial costs of cancer drugs. In a recent issue of the New England Journal of Medicine, an article by Dr. Peter Bach stated that the costs to Medicare of injectable cancer drugs given in doctors' offices increased from $3 billion in 1997 to $11 billion in 2004, an increase of 267% at a time when the costs for the entire Medicare program increased 47%.

It also states that there was a huge reduction in Medicare expenses that occurred when the off-label use of ESAs (drugs for anemia-related issues) was found to actually cause harm to patients. The drugs were proven to be over-used and the net result of expose was that use of these drugs quickly dropped and the costs to Medicare dropped from over $1 billion a year to just $200 million.

In 2003, in the political payback deal of the century, Congress guaranteed premium pricing for pharmaceuticals, by prohibiting Medicare from negotiating drug prices, and it provided hundreds of billions of dollars in U.S. taxpayer subsidies to pay for these premium drug costs. Now the specter of "rationing" is raised.

Dr. Bach stated ways that the Medicare program could control costs. One of those ways was to fund a comparative-effectiveness program to assess whether or not treatments (mostly the newer targeted regimens) are really better than older treatments. Decisions are being made about what cancer treatments patients can actually afford.

Comparative research is not rationing health care. The research funding doled out in the recent Stimulus Package would go to the National Institute of Health, the Agency for Healthcare Quality and Research and the Centers for Medicare and Medicaid Services to focus on producing the best unbiased science possible.

Comparative research has the potential to tell us which drugs and treatments are safe, and which ones work. This is not information that the private sector will generate on its own, or that the "industry" wants to share. Companies want to control the data, how it is reviewed, evaluated, and whether the public and government find out about it and use it. Just about the way they are controlling data now.

Comparative-effectiveness research is not something for patients to be afraid of. It can help doctors and patients, through research, studies and comparisons, undertand which drugs, therapies and treatments work and which don't. Nothing in the legislation will have the government monitoring treatments in order to guide your doctor's decisions. Doctors will still have the ultimate decision, along with the patient.

[Rich66]

from the main article:
"Increasing costs don't necessarily lead to the rationing of health care, Precht said. "But there needs to be cost-effectiveness analysis, so there is some relationship to the effectiveness of the treatment we are paying for," he said."

Yep. So let's heavily fund the most promising global treatments, get a cure..and make the bean counters happy.