Cutbacks in Medicare Chemotherapy Payments Have Little Impact on Care

DURHAM, N.C., Oct. 8 -- Cancer patients are not waiting longer for chemotherapy, nor are they traveling greater distances to receive treatment, despite predictions of access issues when Medicare reduced payment for infusion therapy.

Moreover, even though more Medicare patients said they had difficulty paying out-of-pocket chemotherapy-related expenses after the Medicare cuts, 87% said they were satisfied or very satisfied with the care they received, said Kevin A. Schulman, M.D., of Duke University here, and colleagues.

The findings emerged from a survey of chemotherapy patients who received treatment before and after the 2005 implementation of the Medicare Modernization Act, which reduced the amounts reimbursed for drug acquisition and administration. Survey results were released online ahead of publication in the Nov.15 issue of Cancer.

The investigators conducted the survey via e-mail invitation to a web-based survey tool, and by paper surveys distributed at oncology practices. They received 1,421 responses -- 684 from patients treated from January 2003 through January 2005, and 737 from patients treated on or after Feb. 1, 2005 when Medicare changes were implemented.

Most respondents were white women and the mean age was 60. One-third of the sample had breast cancer, 12% had lung cancer, and 12% had lymphoma. Because the survey was limited to patients who underwent intravenous chemotherapy, prostate and other cancers that are treated primarily by surgery were underrepresented.

Among the findings for patients 65 or older:

• Patients waited a median of three weeks to start chemotherapy both before and after the Medicare changes.
• After adjusting for sex, rural location, cancer type, and race/ethnicity, patients treated after implementation of the payment changes received chemotherapy 2.8 days earlier than those treated before the payment cuts, but the difference was not statistically significant.
• Before the payment changes, 73% of patients received their first course of chemotherapy in hospital infusion centers or infusion centers affiliated with an oncology practice versus 62% of patients treated in those locations after the changes (P=0.02). But after adjusting for sex, rural location, cancer type, and race/ethnicity the difference was no longer statistically significant.
• Both before and after the payment changes 12% of patients said the treatment location changed during their course of chemotherapy.

Patients younger than 65 reported similar experiences as those 65 or older, a finding the researchers said was contrary to their expectations.

The investigators conducted separate analyses of two subgroups -- patients living in rural areas and Medicare beneficiaries without supplemental insurance.

There were significant differences in treatment location for both groups:

• Before payment changes, 34% of rural patients received treatment in outpatient hospital infusion centers compared with 22% after the payment changes (P