Medicare Changes Didn't Alter Cancer Care

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By Alan Mozes
HealthDay Reporter
Monday, October 8, 2007; 12:00 AM

MONDAY, Oct. 8 (HealthDay News) -- A 2003 overhaul of Medicare that changed the way oncologists are reimbursed for their services did not alter cancer patients' perceptions of their quality of care, a new survey found.

The poll also found that cancer patients are waiting the same amount of time for chemotherapy treatments to begin and traveling the same distance to a treatment location as they did before 2003.

"In 2003, Congress changed the way Medicare charges for oncology therapy, and following that there was a lot of controversy and concern that, in fact, patients would be denied access," said study co-author Dr. Kevin Schulman.

"But at least in terms of what we found in this survey, there is no evidence that that has occurred," he said. "We did find some evidence that patients who didn't have supplemental insurance might have some negative changes -- more difficulty with access. But it was a really small number of people -- too small to say that definitively."

Schulman is a professor of medicine and director of the Center for Clinical and Genetic Economics at Duke University's Clinical Research Institute. His team's finding were published online Oct. 8 in the journalCancerand were expected to be published in the Nov. 15 print issue.

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 is widely considered the most sweeping change made to the government-run health insurance program since its inception in 1965.

Key alterations included adding a new prescription drug benefit and expanding subsidies for rural hospitals. At the same time, however, Medicare reimbursements to oncologists for cancer treatments were cut by 30 percent to 40 percent -- raising fears of service cuts, staff lay-offs, facility consolidations, and a resulting drop in patient access to timely quality care, the study authors said.

To gauge how close those fears match reality, Schulman and his colleagues began an Internet survey of cancer patients in 2006.

Approximately 1,400 men and women participated, drawn from every Medicare jurisdiction in the United States. The majority were female and white, with an average age of 60. About one-quarter came from rural areas, and about half said they had private, employer-based health insurance when they began treatment -- insurance that supplemented their Medicare coverage for those 65 and older.

About half the patients had started and finished their chemotherapy treatment between January 2003 and January 2005; the other half began their treatment in February 2005 and continued on.

Patients were asked about their type of cancer, insurance status, income, educational background, race/ethnicity, waiting time for treatment, travel time to treatment facility, changes in facilities or physicians, and overall satisfaction with their care and ability to handle out-of pocket costs.

The study authors found that among those 65 and older, the wait time for chemotherapy treatment following diagnosis was the same both before and after 2003: three weeks.


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