Although science has provided immeasurable hope for cancer patients whose illnesses would have once been incurable, recent actions – or rather inaction – by Medicare signals a clear misunderstanding of the importance of adequate payment policies on the lives of cancer patients nationwide.
Last month, the Centers for Medicare & Medicaid Services (CMS) once again did not address the need to reform hospital payment policy for patients who require stem cell or cord blood transplants in the hospital setting. By failing to address chronic underfunding in its FY2018 hospital inpatient prospective payment system (IPPS) proposed rule, access to life-saving transplants may become out of reach for some seniors who must rely upon Medicare for coverage.
No one wants to hear that he or she has cancer. Yet, when this happens and you are told that there is a possible cure through transplant but that your hospital may not provide it because reimbursement rates do not cover the cost of providing the care — it is simply unfathomable.
Blood cancers – like lymphoma, myeloma, and leukemia – are diagnosed every three minutes, and every nine minutes, someone dies from these diseases in the United States. These cancers are especially difficult to treat in older Americans because of complications and comorbidities that occur as we age. However, advances in the science behind transplants from stem cell and cord blood have enabled these Americans to not only survive their once-terminal blood cancers, but to be cured of them.
It’s a fairly new development, but one that will make little difference if CMS doesn’t fund the cost of acquisition and transplant of stem cell and cord blood similarly to how the agency funds the acquisition and transplant costs for solid organs. Only in the past 10 years has transplantation in adults ages 65 and older become a viable treatment option, and since 2005, transplants for this population have increased from less than five percent to 16 percent of all allogeneic transplants.
Whereas once this group was only offered “supportive” care and therapies, the availability of a cure has been transformative. It is time for CMS to act and eliminate the disparity between solid organ and stem cell/cord blood transplants.
While policymakers at CMS did act late last year to address funding for stem cell and cord blood transplants in the outpatient setting, funding for inpatient care is as, if not more, critical to this patient population. 97 percent of these transplants take place in the inpatient setting and are frequently the only realistic option. Patients are prone to infection, are sometimes critically ill and require ongoing testing, interventions and monitoring leading up to, and following, a transplant. In fact, it’s a process that can often include a 20- to 30-day hospital stay. Currently, Medicare reimburses for this care, as well as the cost of acquiring transplantable cells, under a single amount, which falls thousands of dollars below the actual costs to the hospital.
It’s a figure that falls far short of what’s needed to pay for intensive, complex and lifesaving care, and it threatens hospitals’ willingness to take on Medicare patients.
In the wake of CMS’ decision not to even mention the issue in the recently released Proposed Rule or provide adequate funding in the inpatient setting for these transplants, hospitals across the country will face the decision of whether or not to offer complex, staff-intensive, expensive care that will not be fully reimbursed.
Patients and their families will have to decide if they can afford the crushing medical debt that can accompany financing one’s own cancer treatments out of pocket. These are not the types of decisions we should force anyone to make, let alone older Americans living with cancer.
It’s long past time for CMS to step in and help correct the situation. It’s time they act to implement policies that treat stem cell and cord blood transplants in the same manner they address solid organ transplants – by reimbursing the costs of acquiring those organs separately from the related inpatient care. It’s time for policymakers to step up and recognize that inaction on this important healthcare issue could seal the fate of millions of Americans with blood cancers and other life-threatening blood disorders.
I urge Medicare to consider the needs of these cancer patients and revise their proposed 2018 inpatient payment rule and increase needed funding for stem cell and cord blood transplant for America’s Medicare beneficiaries.
Daniel Couriel, M.D., is the Director of the Bone Marrow Transplant Program, Huntsman Cancer Institute at the University of Utah.