Industry Voices—Congress needs to pass a fair, common-sense Medicare policy to aid seniors with blood cancer

Krishna Komanduri, M.D.

Thanks to advances in medical science and clinical care, modern therapies are more likely than ever to cure previously fatal blood cancers, including leukemia. Medicare, a critical healthcare insurer for an increasing number of Americans, ensures Medicare beneficiaries who face cancer diagnoses have access to high-quality medical care necessary to extend and maintain the quality of their lives. Unfortunately for many individuals who require lifesaving therapies for blood cancers, Medicare does not provide the security or coverage they deserve.

Unlike blood cancer patients with commercial insurance, Medicare recipients have found it difficult to access the bone marrow, peripheral blood stem cell or cord blood transplant (cellular transplants) that are, in many cases, their only option to treat—and potentially cure—their devastating cancer diagnoses. This is because current Medicare payment policy fails to reimburse hospitals for the costs associated with these treatments.

Whenever a hospital treats patients for their blood cancers, Medicare provides the hospital with an inpatient base reimbursement rate of slightly more than $62,000. Though this might seem high, the reimbursement rate barely covers the cost of cell acquisition, which can cost up to $60,000 or, the cost of two cord blood units, $100,000. This figure does not include the high costs of acquiring the cells (often after an extensive search for donors), screening the generous donor to ensure he or she qualifies for the procedure, testing and typing the blood or marrow, and managing the complex logistics associated with the transplant.

Nor would Medicare be able to cover the cost of recovery, which typically involves a 20- to 30-day hospital stay.

As a result, hospitals that perform blood and marrow transplants can lose tens of thousands of dollars on every Medicare patient they treat. This creates a dangerous disincentive for hospitals to not provide the fundamental treatments that beneficiaries diagnosed with blood cancer desperately need. While no hospital wants to turn away patients, especially those from whom a transplant is the only opportunity for a cure, many are forced into making those very decisions. This situation is not one that the healthcare community and country can sustain.

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At one time, this unacceptable situation threatened to haunt the recipients of solid organs. Recognizing this fundamentally flawed policy, the Centers for Medicare & Medicaid Services created rules to reimburse hospitals on a reasonable cost basis for acquiring lungs, livers and kidneys. In addition, Medicare was required to provide a separate Medical Severity Diagnosis Related Group (MS-DRG) payment for the transplant procedure and inpatient hospital stay. Thanks to this sensible measure, solid organ recipients have access to affordable transplants and hospitals have been able to maintain financial sustainability.

Unfortunately for the thousands of Medicare recipients who are diagnosed with a blood cancer or other blood disorder for which a bone marrow or cord blood transplant is the only curative option, access to blood and marrow transplants may be compromised. Thus, it is now more important than ever for Congress to step up its commitment to Americans who rely upon a life-saving transplant by passing H.R. 4215, the Protect Access to Cellular Transplantation (PACT) Act. This legislation would require Medicare to reimburse bone marrow and cord blood transplantation using the method that is used to reimburse hospitals for solid organs. 

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The American Society for Blood and Marrow Transplantation (ASBMT), an international professional membership association of more than 2,200 physicians, investigators and other healthcare professionals from more than 45 countries, supports the bipartisan the PACT Act, a bill that would finally modernize the country’s system for reimbursing non-solid organ transplants. Introduced by Reps. Doris Matsui (D-Calif.), Ron Kind (D-Wis.), Erik Paulsen (R-Minn.) and Gus Bilirakis (R-Fla.), the bill would protect access to transplant for Medicare beneficiaries so that they too can receive the lifesaving treatments.

No longer should our seniors agonize over whether they can afford transplants that are proven to be effective in treating blood cancer. It’s time for Congress to pass this fair and commonsense Medicare policy.

Krishna Komanduri, M.D., is the immediate past president of the American Society for Blood and Marrow Transplantation and is the director of the adult stem cell transplant program at University of Miami Miller School of Medicine. ASBMT is an international professional membership association of more than 2,200 physicians, investigators and other healthcare professionals from more than 45 countries.