Last year, the Centers for Medicare and Medicaid Services enacted a significant policy change improving access to blood and marrow transplants for Medicare patients diagnosed with life-threatening blood cancers. The change came in the form of a Medicare rule on how outpatient blood and marrow transplants are reimbursed by the federal health care program beginning on Jan. 1, 2017.
While this move a step in the right direction, this rule does not address the vast majority of transplants (97 percent) that are performed in the inpatient setting. Sadly, Medicare continues to provide inadequate reimbursement to hospitals performing inpatient transplants and this limitation threatens to limit access to seniors needing this lifesaving therapy.
It is estimated that a new patient is diagnosed with a blood cancer every three minutes. More than 170,000 Americans will receive a blood cancer diagnosis like leukemia, lymphoma or myeloma this year alone; approximately 1.2 million Americans currently live with these diseases.
Blood and marrow transplants using a donor (“allogeneic” transplants) remain the only curative treatment for many blood cancers. The process of transplantation typically involves treating the patient with chemotherapy and then restoring healthy cells in the recipient by an infusion of blood or bone marrow stem cells, obtained from a matched related or unrelated donor or from umbilical cord blood. These donor cells also help to eliminate any cancer cells that survive chemotherapy.
The fatal blood diseases that require transplants occur most commonly in older individuals, who are also most likely to be covered by Medicare. Historically, the risks of transplant were too great to allow us to safely transplant many seniors. However, rapid clinical advances have resulted in dramatically improved outcomes in older adults. In fact, patients over the age of 65 are now the most rapidly growing population in U.S. transplant centers.
Despite the overwhelming clinical evidence demonstrating the curative potential of transplants in older patients, transplant access for seniors is threatened by Medicare’s chronic underfunding for both the transplant itself and the costs required to obtain matched bone marrow or cord blood. Medicare, for the most part, adequately reimburses transplants of solid organs such as hearts and lungs, appropriately covering the costs of acquiring those organs.
Surprisingly, Medicare treats the cost of acquiring bone marrow differently. Currently, Medicare pays for the cost of acquiring bone marrow and the transplant procedure and hospitalization in a single payment. Unfortunately, the amount currently reimbursed falls well short of the costs of providing the complex care required for blood and marrow transplant recipients, who are vulnerable to complications including infections in the post-transplant period. Unlike solid organ transplants, the cost of obtaining unrelated donor blood, bone marrow or cord blood is not directly and completely reimbursed.
This inadequate reimbursement threatens the ability of transplant centers to continue to take on the complex care of seniors with blood cancers. Unless reimbursement policies change, some seniors may face limited access to their only curative treatment option.
Thanks to national investment in research and continued innovation, seniors diagnosed with cancer today have more treatment options than they had in the past. Poor federal reimbursement policies must be updated to provide patients with access to the treatments that offer them the best possible outcomes, including transplantation.
While last year’s policy change was a marked improvement in reimbursement for those three percent of transplants occurring in the outpatient setting, it is important that similar payment reforms now address the majority of blood and marrow transplants that are performed as inpatient procedures.
I urge Medicare to revise its payment policies for blood and marrow transplants to strengthen reimbursement in the inpatient hospital setting to ensure American seniors the full range of life-saving treatment options for cancer that they deserve.
Krishna Komanduri is president of the American Society for Blood and Marrow Transplantation and the Kalish Family Chair in Stem Cell Transplantation, Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.
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