No significant changes in access to chemotherapy despite Medicare Modernization

Since the Medicare Modernization Act was passed in 2003, changes in patient wait times and travel distances for chemotherapy have been slight.

“When the Medicare Modernization Act of 2003 was enacted, many opponents (including consumer groups) worried about how the changes in reimbursement structures for the care of Medicare-covered cancer patients would impact the quality of care and the logistics of obtaining care,” Jeffrey Wahl, JD, told HemOnc Today. “The results of the study are important for Medicare patients, who should be glad to hear that it basically is ‘business as usual’ for most types of chemotherapy treatment in the post-MMA world.”

Researchers from Duke University assessed a 5% national sample of claims made between 2003 and 2006 from the Centers for Medicare and Medicaid Services. Beneficiaries had incident breast cancer, colorectal cancer, leukemia, lung cancer or lymphoma and received chemotherapy in inpatient hospitals, institutional outpatient or physician offices.

Incident cancer cases numbered 5,082 in 2003, 5,379 in 2004, 5,116 in 2005 and 5,288 in 2006. The researchers reported a small change in the distribution of treatment settings between 2003 and 2006 (P=.02), compared with insignificant changes from 2003 to 2004 and 2005 (P=.24 and P=.72).

The rate of patients undergoing chemotherapy in physician offices remained highest (P=.29), though the researchers reported an increase in the number undergoing chemotherapy at outpatient settings (21.1% to 22.5%; P=.004) and a decrease in the rate at inpatient settings between 2003 and 2006 (10.2% to 8.8%; P=.03).

Not feeling the effects

Despite encouraging observations, Wahl acknowledges the fact that this study may be a bit premature.

“The effects of MMA may not have completely trickled down to the consumer/patient level,” said Wahl, who is a HemOnc Today Editorial Board member. “At some point, the reduced staff might not be able to accommodate the increased expectations of delivery of care and the ultimate financial ‘hit’ could set in, affecting physician providers.”

Wait times for chemotherapy increased by 1.96 days in 2005 compared with 2003 (P=.35). The researchers reported an increase in median travel distance of one mile between 2003 and 2004-2006 (7 miles vs. 8 miles). Average travel distance remained a bit longer in 2004 (1.47 miles; P<.001), 2005 (1.19 miles; P<.001) and 2006 (1.30 miles; P<.001), compared with 2003.

“For physicians, it should be reassuring to note that the delivery of cancer care services has, for the most part, been unaffected by the shifting of reimbursement dollars from one account to another under MMA. It would be interesting for these investigators, or others, to do a follow-up study in another three to four years to evaluate whether MMA has caused the physician-centric and patient-centric results that its initial detractors had predicted.” – by Stacey L. Adams

Shea AM, Curtis LH, Hammill BG, et al. Association between the Medicare Modernization Act of 2003 and patient wait times and travel distance for chemotherapy. JAMA. 2008;300:189-196.