Expand Access to Bone Marrow Transplants for Older Americans

Hope and optimism are powerful forces to cope with a potentially terminal cancer diagnosis. For older Americans with blood cancers and blood disorders — for whom treatment options are historically limited and outcomes typically poor — it is often positivity, trust and confidence in medical science that gets them through the darkest days.

Remarkably, medical and technological advances have allowed for groundbreaking treatment options that should not only encourage older patients to hope for — but even expect — cures for their blood cancers and blood disorders. Today, bone marrow and cord blood transplants provide the only curative options for more than 70 conditions, including diseases such as leukemia, Myelodysplastic Syndrome and sickle cell anemia, and are being used with greater success and frequency in Medicare-age patients than ever before.

But these types of treatments only work when patients can access them. Unfortunately, outdated Medicare policies could grind progress to a halt, taking the hope of thousands of Medicare patients with it.

Earlier this month, the Centers for Medicare and Medicaid Services failed to address underfunding of bone marrow and cord blood transplants in the inpatient setting, which is devastating news for cancer patients and the hospitals that treat them. Unlike solid organ transplants, for which organ acquisition costs are reimbursed by CMS on a reasonable cost basis, the cost of providing bone marrow or cord blood for a marrow transplant is reimbursed in a way that does not adequately recognize the cost of acquiring these cells. By combining acquisition costs with the other costs of transplants including a 20- to 30-day hospital stay, medically qualifying the selected donor, testing and typing, infectious disease screening, and dealing with patient complications, current reimbursement significantly underfunds the true cost of transplant.

Unless CMS takes action immediately to update this policy and align it with solid organ transplant policy, hospitals will be expected to perform transplants at a financial loss. It’s a situation that places strain on our nation’s transplant programs and threatens access for Medicare patients in need of transplant for survival.

It’s terrible news after several years of great progress.

For years, the standard of care for patients age 65 or older with certain blood cancers and disorders has been either chemotherapy or supportive therapy — blood transfusions that help temporarily alleviate symptoms and treatment of infections that often occur — while younger patients had access to the curative benefit of transplant. Recently, medical advancements made it possible to offer transplant to older patients. This is great news since older patients are more likely to experience diseases like leukemia or lymphoma.

In just the past decade, transplant has increasingly become the standard of care for many patients in this age group. Since 2005, transplants in the 65 and older population have increased from less than 5 percent to 16 percent, with remarkable success. Research shows that patients age 65 and older have at least the same positive survival outcomes as younger patients. And although the total number of Medicare beneficiaries requiring this type of care is relatively small — approximately 1,800 transplants were performed last year to patients 60 and older — the individual impact is enormous.

The promise of hope for a cure should not be taken away simply because of bad policy decisions in Washington, D.C. Before we strip patients of their optimism for a healthy future, let’s encourage our lawmakers to take a long, hard look at how their policies affect Medicare beneficiaries. Their survival depends on it.


John Miller, MD, is the vice president and senior medical director of the National Marrow Donor Program.

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