facebook-pixel

Commentary: We have the cure for blood cancers but Congress must make it affordable

Hospitals are forced to make the unthinkable choice between incurring huge losses or no longer offering cellular transplant procedures.

Francisco Kjolseth | The Salt Lake Tribune Intermountain Healthcare joins the ranks of other premier institutions such as Duke University and Johns Hopkins by opening the state’s largest and most advanced medical simulation center at LDS Hospital in Salt Lake City. The center is equipped with advanced simulation technology that allows staff the opportunity to develop and practice physical skills, critical thinking, decision-making, collaboration, and communication in a safe, realistic environment.

Francisco Kjolseth | The Salt Lake Tribune Intermountain Healthcare joins the ranks of other premier institutions such as Duke University and Johns Hopkins by opening the state’s largest and most advanced medical simulation center at LDS Hospital in Salt Lake City. The center is equipped with advanced simulation technology that allows staff the opportunity to develop and practice physical skills, critical thinking, decision-making, collaboration, and communication in a safe, realistic environment.

By Julie Asch | For The Tribune
  | July 14, 2018, 6:00 p.m.
| Updated: 5:24 p.m.

As a doctor at the Intermountain Blood and Marrow Transplant Program at LDS Hospital in Salt Lake City, there’s no greater joy than bringing hope to my patients who are battling blood cancers like leukemia and lymphoma. Across the country, more than 1.3 million Americans are fighting these heart-wrenching diseases, with a new patient being diagnosed every 3 minutes.

Over my 23-year career, I have made it my personal mission to fight for my patients by providing the best care possible. This includes offering bone marrow and cord blood transplants, which have proven effective at curing cancers of the blood.

But without help from Congress, Medicare patients are at serious risk of not being able to undergo the procedures they need to survive — even after we find a donor who is a perfect match.

This sad situation is the result of decades-long federal policy, which treats bone marrow and cord blood transplants differently from solid organs. Unlike patients who need kidneys or lungs, Medicare does not cover the cost of search and cell acquisition for blood cancer patients. Moreover, as patients recover from the lifesaving procedures — requiring a 20- to 30-day hospital stay on average — hospitals are forced to take huge financial hits because Medicare’s reimbursement rate does not even come close to covering the true cost of treatment.

As a result, hospitals in Utah and across the country are losing tens of thousands of dollars on each cellular transplant they perform on Medicare patients. Because bone marrow and cord blood transplants are not adequately reimbursed by the system, many hospitals are forced to make the unthinkable choice between incurring huge losses or no longer offering cellular transplant procedures. In order to keep the hospital running, many have chosen the latter.

In April, the Centers for Medicare & Medicaid Services’ (CMS) missed a golden opportunity to propose changes in how cellular bone marrow, peripheral blood stem cell and cord blood transplants are reimbursed. Even as the transplant community has worked closely with policymakers to ensure patient access and financial sustainability, CMS’ 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.

As a physician, I’ve pledged to do everything it takes to save my patients’ lives. That’s why I’m advocating for the bipartisan Patient Access to Cellular Transplant (PACT) Act (H.R. 4215), which would adjust the reimbursement structure for hospitals that provide marrow and cord blood transplants to Medicare beneficiaries beginning October 1. The PACT Act is a necessary and thoughtful fix to the decades of underfunding that have caused many hospitals to question their ability to provide the only curative treatment for blood cancers and other blood disorders to Medicare beneficiaries.

I urge our representatives to support the PACT Act and encourage Sens. Orrin Hatch and Mike Lee to support the introduction of a companion bill in the U.S. Senate. My blood cancer patients — Utah’s brave friends, neighbors and loved ones — are looking to you for hope.

Julie Asch

Julie Asch, M.D., is the program director of the Intermountain Blood and Marrow Transplant Program at LDS Hospital in Salt Lake City.

By Julie Asch | For The Tribune