Americans diagnosed with cancer frequently find themselves racing against an incredibly unfair clock that can have dire consequences on their health outcomes, and even survival.
Did doctors find my cancer in time? How long has it been growing? How soon can I start treatment? Did I start treatment too late? In most cases, the earlier cancers are diagnosed and the sooner interventions happen, the better the chance for recovery. Delays can be deadly.
{mosads}Today, cancer patients, health care providers, and cancer care advocates are watching the clock tick by on another critical issue that becomes both more frustrating and urgent with each passing day.
Medicare reimbursement for cellular transplants – like bone marrow, blood stem cells and cord blood – continues to fall far short of what it costs to provide care. And each passing month without resolution endangers the future of lifesaving – often curative – treatments for those Americans with deadly blood cancers.
Much like solid organ transplants – such as kidney and liver – cellular transplants often give patients their best shot at survival. For those suffering from leukemia, lymphoma or myelodysplastic syndromes, cellular transplants in many cases provide a cure.
But unlike solid organ transplants, which are more appropriately reimbursed by Medicare, cellular transplants are woefully under-reimbursed – causing providers to lose tens of thousands of dollars on every patient they treat and endangering the future of this important care.
For example, current Medicare reimbursement does not fully cover cell acquisition costs, like medically qualifying the selected donor, testing and typing the sample, and providing extensive infectious disease screening. It also does not fully cover the average 27-day in-patient stay required for most patients to safely undergo the treatment. Rather, Medicare reimburses a mere fraction of what it typically costs for patients to receive this incredibly complex care – leaving hospitals and providers with significant financial losses.
Even though a relatively small number of Medicare beneficiaries actually need this care (approximately 1,200 people each year, age 65 and older), it can mean the difference between life and death. Unfortunately, many hospitals are facing the unthinkable choice between incurring huge losses by treating these older Americans, or halting their cellular transplant programs altogether.
In April, as the clock ticked, the Centers for Medicare and Medicaid Services (CMS) missed a golden opportunity to bring cellular transplant funding to where it needed to be by addressing it in the FY2019 Hospital Inpatient Prospective Payment System (IPPS) Proposed Rule. Instead, they left providers scrambling to determine the feasibility of their transplant programs, and patients in fear of being able to access the cancer care they need.
It’s time that Congress put an end to this agonizing guessing game.
The Protect Access to Cellular Transplant (PACT) Act, H.R. 4215, would update Medicare policy to reimburse hospitals for the cost of acquiring bone marrow, blood stem cell, and cord blood cells the same way solid organ acquisition costs are paid. Co-sponsored by Reps Erik Paulsen (R-Minn.), Ron Kind (D-Wis.), Doris Matsui (D-Calif.) and Gus Bilirakis (R-Fla.) in the House of Representatives, it would offer stability and fair payment for providers – and hope for patients racing against the clock.
There are too many obstacles, too much stress, and too many unfair realities when it comes to fighting cancer. We need Congress to act now to give Americans with blood cancers help and hope for their future.
Brian Lindberg is chief policy officer, chief legal officer and general counsel of National Marrow Donor Program/Be the Match.