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Medicare changes don’t affect cancer care: study

WASHINGTON – Legislation that cut fees doctors receive for giving chemotherapy to Medicare patients has not affected care so far, researchers reported.

Some groups complained the Medicare Modernization Act of 2003, which cut payments to doctors, would prompt physicians to drop patients or cut back on services.

But Alisa Shea of the Duke University School of Medicine in North Carolina and colleagues found no evidence Medicare patients had to travel any farther to get chemotherapy, or look any harder to find an oncologist to treat them.

“The Medicare Modernization Act took issue with the fact that oncologists were often reimbursed too much — sometimes as much as three times what they had paid — for the chemotherapy drugs they were giving their patients, and subsequently doctors saw those reimbursement payments fall,” said Dr. Kevin Schulman of Duke, who led the study.

“The concern was that patient care would suffer if doctors had to close their practices or scale back, making it necessary for patients to travel farther or go to inpatient facilities for treatment. Our study showed that this, in fact, has not yet occurred.”

Writing in the Journal of the American Medical Association, the researchers said they analyzed 5 percent of claims from Medicare, the federal health plan for 44 million elderly and disabled people, for 2003 through 2006.

The sample included more than 20,000 Medicare beneficiaries with newly diagnosed breast cancer, colorectal cancer, leukemia, lung cancer or lymphoma.

In 2003, 10 percent of patients got chemotherapy as inpatients. This fell to 8.8 percent in 2006, as the proportion of patients treated in physicians’ offices remained at 68.7 percent. The rest were outpatients at hospitals or big clinics.

The average time from diagnosis to first chemotherapy treatment was around 28 days throughout the study.

The median distance traveled to treatment was 7 miles (11 km) in 2003 and 8 miles in 2004 through 2006.

“We did find that patients in rural areas tended to have to wait longer to begin their chemotherapy after diagnosis — their wait times increased by up to five days from 2003 to 2006,” Curtis said in a statement.

“Whether this is something that could have a negative effect on treatment outcomes is still unknown, but it is something we should continue to follow.”

The aging of the U.S. population is expected to lead to a doubling in cancer patient numbers in the next 30 years.

Groups like the American Medical Association and AARP, which represents people over 50, are lobbying for legislation that would reverse a 10 percent cut in Medicare reimbursement to doctors that took effect on July 1.

The groups say the cut could hurt seniors’ access to medical care because doctors will be unable to afford to treat them and will drop Medicare patients.