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Cancer Care Unaffected by Doctor Reimbursement Changes

Study says Medicare Modernization Act yet to show drop-off in access predicted by critics

TUESDAY, July 8 (HealthDay News) -- Chemotherapy patients have not lost access to care despite federal legislation that has reduced reimbursements to their doctors in recent years, a new report finds.

Critics feared the passing of the Medicare Modernization Act of 2003 would make treatment more difficult, but investigators from the Duke Clinical Research Institute (DCRI) found little difference in the distance chemo patients traveled to be treated and the time between diagnosis and start of treatment.

"The Medicare Modernization Act took issue with the fact that oncologists were often reimbursed too much -- sometimes as much as three times what they had paid -- for the chemotherapy drugs they were giving their patients, and subsequently, doctors saw those reimbursement payments fall," senior study investigator Dr. Kevin Schulman, director of the DCRI's Center for Clinical and Genetic Economics, said in a prepared statement. "The concern was that patient care would suffer if doctors had to close their practices or scale back, making it necessary for patients to travel farther or go to inpatient facilities for treatment. Our study showed that this, in fact, has not yet occurred."

The researchers studied the treatment of people with leukemia, lymphoma, breast, lung or colorectal cancer from across the United States from 2003, before the act passed, through 2006.

"The distance patients traveled for chemotherapy treatments did not considerably increase after passage of the act," lead investigator Lesley Curtis, a health services researcher in the DCRI, said in a prepared statement. "And despite concerns that patients would have to go to inpatient settings with longer wait times to be treated, we observed a small shift in the provision of initial chemotherapy from inpatient to outpatient settings between 2003 and 2006."

The median amount of time between diagnosis and chemotherapy was 28 days and did not change significantly, regardless of the treatment settings between 2003 and 2006, Curtis said.

"We did find that patients in rural areas tended to have to wait longer to begin their chemotherapy after diagnosis -- their wait times increased by up to five days from 2003 to 2006," Curtis said. "Whether this is something that could have a negative effect on treatment outcomes is still unknown, but it is something we should continue to follow."

The findings were published in the July 9 issue of the Journal of the American Medical Association.

The lower reimbursement may still have long-term effects that have yet to be realized, Curtis cautioned.

More information

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-- Kevin McKeever

SOURCE: Duke University Medical Center, news release, July 8, 2008

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