ASCO Medicare chatter

[Rich66]

http://www.asco.org/ascoaction

[gdpawel]

Another study adds to the numerous other studies over the years that have shown the benefits of the Medicare Modernization Act (MMA). Duke University studies had shown the MMA did not change cancer chemotherapy as feared. They showed that millions of dollars were saved and patient quality was still the same. And since oncology drugs accounted for about 69% of total Part B spending on prescription drugs and related services, the Medicare Part D plan made it more important for Medicare cancer patients. The fact that medical oncologists received no reimbursement for providing oral-dose therapy to cancer patients had been the principal barrier to the availability of the oral-dose protocol. Compared to infusional therapy, oral-dose anti-cancer drugs can make receiving cancer treatment more convenient for patients by allowing flexibility in taking medication without disrupting work or other activities. They often resulted in less time (or not time) spent in office-based oncology practices because of the absence of intravenous administration and its related side-effects.

However, Medicare’s payment cuts for chemotherapy drugs didn’t really change the patterns of treatment. Besides the recent Health Affairs publication (How Medicare’s Payment Cuts For Cancer Chemotherapy Drugs Changed Patterns Of Treatment), a survey in Dr. Neil Love’s “Patterns of Care” and Newhouse and Earle’s previous Michigan/Harvard study (Does reimbursement influence chemotherapy treatment for cancer patients?), they all show results that the Medicare reforms are still not working. An impossible conflict of interest still exists. The existence of profit motive in drug selection has been one of the major factors working against the individualization of cancer chemotherapy. It is way past time to take medical oncologists out of the retail pharmacy business and force them to be doctors again.

http://cancerfocus.org/forum/showthread.php?t=687

[hutchibk]

It's important to remember that oncology is not only chemotherapy. Medicare severely rations radiation oncologists as we speak. I know from experience, because my rads onc was only paid for about 1/3 - 1/2 of my brain, infindibulum and bone mets rads in the last 18 months (he appealed to the full allowance of 4 appeals and was denied every time), because they deemed that my cancer did not require the amount of fractions that he prescribed... he is a tremendously respected and published scientist and radiochemist, but apparently they know better what I need. If he only treated medicare patients, his practice would be out of business. That says to me that Medicare has the potential to be VERY bad for cancer patients, when they have the power to eventually run the best in the field out of business.

[gdpawel]

I wrote to Earle and Newhouse, co-authors of the Michigan/Harvard study and the latest study published in Health Affairs and asked them if there was an incentive for radiation oncologists at community cancer centers to chose whole brain radiation treatments, as these were the most expensive, for them.

Could their methodology collect data documenting a clear association between reimbursement to radiation oncologists for whole brain radiation treatment which is based on how much incentive occurs to the radiation oncologist?

They thought that there were similar issues, but their methodology would be different because radiation isn't something that individual doctors buy, sometimes at a discount, and then profit from if they're reimbursed more for it, as in the case with chemotherapy.

They relied upon price variation across regions in Medicare, which was pseudo-random and had been eliminated. To their knowledge, there was no comparable price variation in radiology that they could have used.

However, they did mention a radiation oncologist in Michigan, who had done some work looking at the number of palliative fractions of radiation given to patients with advanced lung cancer as being a situation in which there is a lot of discretion on the part of the physicians: one fraction is as good as 10, but 10 will reimburse more.

[hutchibk]

I did not have WBR, and he and I have had MANY conversations about how he approaches treatment regimens. My Rads Onc is not at a community clinic, he is the sole physician at the practice. His machines and treatment approaches are at least comparable to, yet thought by many to be superior in many applications to, Cyber, Gamma and Proton. And it is less expensive... not nearly as "sexy" a brand name as those.

Medicare rationing will be the death of me long before cancer. Of that I am pretty confident.