Medicare modernization act did not change chemotherapy as feared

October 08, 2007

DURHAM, N.C. -- Cancer patients receiving chemotherapy have not noticed a restriction in their access to treatment following the enactment of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), despite the act's significant reduction in government reimbursement to oncologists, according to a new study led by researchers in the Duke Clinical Research Institute (DCRI).

"Critics of the MMA often said that it would reduce patients' access to chemotherapy services, because doctors would receive 30 to 40 percent less reimbursement from the government for administering treatment," said Kevin Schulman, M.D., director of the DCRI's Center for Clinical and Genetic Economics, and senior investigator on the study. "Our study showed that patients actually do not perceive barriers to their access to chemotherapy and perceptions about access are really the same among patients who received treatment before the legislation went into effect, and those who received it afterwards."

The team's findings will be published in the November 15, 2007 print edition of the journal Cancer, but also will appear earlier in the journal's October 8, 2007 online edition. The study was funded by a grant from the National Patient Advocate Foundation's Global Access Project, which brings together 42 national healthcare stakeholder groups -- such as pharmaceutical companies and advocacy groups -- to fund health research projects. The Project has focused on examining the MMA's consequences for patients, providers and healthcare systems.

The Duke researchers examined the results of 1421 surveys completed via the internet by 684 patients who had received chemotherapy prior to the enactment of the MMA and 737 patients who were treated after it went into effect. Respondents answered questions related to issues including the amount of time they waited to start chemotherapy after their initial cancer diagnosis, and how far they had to travel to get their treatments.

"When the act was passed in 2003, many doctors and patient advocates were concerned about the consolidation of services it might necessitate, such as the moving of chemotherapy services to hospital rather than outpatient settings and the elimination of staff positions," said Joelle Friedman, a DCRI researcher and lead author on the paper. "They were afraid these changes would affect patients' access to care, but our study showed that these concerns turned out to be largely unwarranted."

About half of the patients surveyed in each group were under the age of 65 and half were over 65. The majority of patients in each group reported being either satisfied or very satisfied with the care they received from their oncologists, Friedman said.

The researchers also found no difference in the amount of time from diagnosis to initiation of chemotherapy between the two groups; the median lapse in time was 22 days in both groups, Friedman said.

Patients reported an average travel time of 30 minutes to the location of their chemotherapy appointments, both before and after the implementation of the act, she said.

The speculation that treatment location would change -- that patients would either be forced to travel farther for therapy or switch treatment locations in the middle of therapy -- also proved to be unfounded, Friedman said.

The MMA represented the largest overhaul of the Medicare system since it was created in 1965. Changes included a new prescription drug benefit, and a $25 billion allocation of funds to rural hospitals. One key provision, however, was a significant reduction in Medicare reimbursement to healthcare providers. Oncologists were strongly affected, due to a perception that they had been over-compensated in the past.
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Other researchers involved with this study were Lesley Curtis, Bradley Hammill, Jatinder Dhillon, Charles Weaver, Sugata Biswas and Amy Abernethy.

Duke University Medical Center

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