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Medicare law did not restrict access to chemotherapy
Law did include significant reduction in government reimbursement to oncologists.
Patients with cancer 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.
“Critics of the act often said it would reduce patients’ access to chemotherapy services, because doctors would receive 30% to 40% less reimbursement from the government for administering treatment,” Kevin Schulman, MD, director of the Duke Clinical Research Institute Center for Clinical and Genetic Economics, said in a press release.
“Our study showed that patients actually do not perceive barriers to their access to chemotherapy. Perceptions about access are really the same among patients who received treatment before the legislation went into effect and those who received it afterward,” Schulman said.
Results of the study are published in Cancer.
The Medicare Prescription Drug, Improvement and Modernization Act of 2003 was the most comprehensive restructuring of the Medicare system since its introduction in 1965. Changes included a new prescription drug benefit, managed care insurer access and $25 billion allocated to rural hospitals.
One key provision, however, was a significant reduction in Medicare reimbursement to health care providers that went into effect Jan. 1, 2005. In particular, cancer treatment was targeted with reduction because it was considered by legislators to have been overly generous.
“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. They were afraid these changes would affect patients’ access to care, but our study showed that these concerns turned out to be largely unwarranted,” Joelle Friedman, MPA, a researcher at Duke Clinical Research Institute, said in a press release.
Patient satisfaction
Researchers at Duke University collected 1,421 surveys via the internet that included 684 patients who had received chemotherapy prior to the Medicare act and 737 patients who had received chemotherapy after it.
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.
Most patients in each group reported being either satisfied or very satisfied with the care they received from their oncologists.
Regardless of age, patients treated before and after the Medicare act reported a median wait to treatment time of 21 days and an average travel time of 30 minutes. Overall, there was no significant difference in treatment location between the two groups.
A small trend in change of location was observed for patients living in rural areas and patients with Medicare and no supplemental insurance. However, the number of patients in these subgroups was too small to make an association.
For more information:
- Friedman JY, Curtis LH, Hammill BG, et al. The Medicare modernization act and reimbursement for outpatient chemotherapy: Do patients perceive changes in access to care? Cancer. 2007;doi:10.1002/cncr.23042. Accessed Oct. 9, 2007.