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Medicare Modernization Act not associated with major changes in access to chemotherapy
Date:7/8/2008

percent sample of claims from the Centers for Medicare & Medicaid Services for the period 2003 through 2006. Patients were Medicare beneficiaries with new breast cancer, colorectal cancer, leukemia, lung cancer, or lymphoma who received chemotherapy in inpatient hospital, institutional outpatient, or physician office settings. In this sample, there were 5,082 new cases of breast cancer, colorectal cancer, leukemia, lung cancer, or lymphoma in 2003; 5,379 cases in 2004; 5,116 cases in 2005; and 5,288 cases in 2006.

In each year, approximately 70 percent of patients had their first chemotherapy visit in a physician office, and no more than 10 percent received chemotherapy in an inpatient hospital setting. The distribution of treatment settings in 2003 was not significantly different from 2004; however, there was a small but significant difference between 2003 and 2006. The proportion of patients receiving chemotherapy in inpatient settings decreased from 10.2 percent in 2003 to 8.8 percent in 2006, and the proportion of patients in institutional outpatient settings increased from 21.1 percent to 22.5 percent. The proportion of patients in physician offices remained at 68.7 percent.

The median (midpoint) time from diagnosis to initial chemotherapy visit was 28 days in 2003, 27 days in 2004, 29 days in 2005, and 28 days in 2006. Average wait times for chemotherapy were 1.96 days longer in 2005 than in 2003 but not significantly different in 2006 (0.88 days). Median travel distance was 7 miles in 2003 and 8 miles in 2004 through 2006. After adjustment, average travel distance remained slightly longer in 2004 (1.47 miles), 2005 (1.19 miles), and 2006 (1.30 miles) compared with 2003.

"As measured by travel distance and time to chemotherapy, our findings do not support anecdotal reports that the enactment of the MMA has changed access to chemotherapy in a meaningful way. Given the slow transition to full implementation of the reimbursement change
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Contact: Michelle Gailiun
919-660-1306
JAMA and Archives Journals
Source:Eurekalert

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