Each year, approximately 350 people diagnosed with a blood cancer or other blood disorder receive a life-saving bone marrow or cord blood transplant at Duke University Medical Center.
Some are fortunate to receive the gift of donation from a family member or anonymous donor. Many others must simply wait and endure the fear and frustration when a cure is possible but remains out of reach.
Although I won’t begin to compare my frustration level with that of my patients, the transplant community has also been enduring something of an agonizing waiting game.
We have been in desperate need of policy updates that would ensure hospitals are adequately reimbursed for cellular transplants that can cure blood cancers like leukemia, lymphoma and Myelodysplastic Syndromes. We have been working with policy makers to help them understand that cellular transplants deserve the same kind of appropriate funding provided for transplants of solid organs, like kidneys, liver and lungs.
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We thought we might be close to a much-needed and long-awaited solution. But unfortunately, late last month, the Centers for Medicare & Medicaid Services (CMS) failed to propose a payment policy change for Medicare’s reimbursement of cellular bone marrow, peripheral blood stem cell and cord blood transplants.
As a result, and much to the dismay of the transplant community, the fiscal year 2019 Hospital Inpatient Prospective Payment System (IPPS) proposed rule will not appropriately reimburse donor search and cell acquisition costs for these essential treatments, unless the Congress steps in and changes the policy through legislation.
It’s a decision that makes little sense when you consider the facts.
For decades, Medicare and Medicaid have reimbursed hospitals that perform solid organ transplants by paying independently for the cost of acquiring the organ and the related inpatient stay and intense care. However, when it comes to cellular transplants, Medicare and Medicaid reimburses hospitals a single amount that falls far short of covering both the 20- to 30-day hospital stay and the cost of cell acquisition.
Hospitals that lose tens of thousands of dollars each time they treat a Medicare or Medicaid patient will face tremendous obstacles keeping their transplant programs viable long term. And that’s another worry that our cancer patients simply shouldn’t have to endure.
In the absence of a regulatory solution, Congress has the ability to fix the problem and should act now that the Administration has made it clear it will not.
Introduced by bipartisan lawmakers in the House of Representatives, H.R. 4215 – The Patient Access to Cellular Transplant (PACT) Act – would adjust the reimbursement structure for hospitals that provide marrow and cord blood transplants to Medicare and Medicaid beneficiaries beginning Oct. 1, 2018. Critically, the change would actively address chronic underfunding that has caused many hospitals to question their ability to provide the only curative treatment for blood cancers and other blood disorders to Medicare and Medicaid beneficiaries.
Every day, I arrive to see my patients, committed to helping them survive their cancer through whatever means we have available. Transplant centers – and patients’ access to them for lifesaving care – remain one of the most important tools in our arsenal. But as the reimbursement situation stands, it is simply not sustainable. It’s time that lawmakers take reasonable, and long overdue, steps to ensure a cure for blood cancers and other life-threatening blood disorders and certain genetic diseases remains available.
Joanne Kurtzberg, M.D., is the Jerome Harris Distinguished Professor of Pediatrics and professor of pathology at Duke University Medical Center and the director of the Marcus Center for Cellular Cures, the Carolinas Cord Blood Bank, and the Pediatric Blood and Marrow Transplant Program, as well as co-director of the Stem Cell Transplant Laboratory.