Medicare And A New Breast Cancer Treatment

A couple of years ago Shirley had a lump removed from her breast. The normal procedure following such surgery would be 25 to 30 X-ray sessions over a period of five to six weeks. But she participated in a study of Intraoperative Radiation Therapy that was being tested on qualified patients with certain early stage breast cancers. The procedure was done in the operating room and took about 45 minutes of additional time in surgery. That was it. We went home and continued to live our lives with only routine follow-ups. Studies show that Intraoperative Radiation Therapy is as effective as conventional treatments and is less expensive and less demanding on the woman.
While just now being used at a few hospitals to treat breast cancer patients, the procedure has been around for some time to treat other types of tumors. Medicare pays for this type of treatment. But starting January 1, 2012 Medicare is changing the way it pays. Instead of paying for the procedure separately as it now does, Medicare plans to bundle the cost of the procedure with the cost of the surgery. The whole issue is explained in a PDF file.
The immediate result is that hospitals will no longer be reimbursed for the extra time in the operating room. The longer term result will no doubt be that hospitals will be unable and unwilling to provide the procedure due to high recurring costs.
Just as Intraoperative Radiation Therapy is joining the toolkit to combat breast cancer, hospitals will be unlikely to provide it. Yet, the cost savings to Medicare over conventional treatment for early stage breast cancer are very significant. If this doesn’t make sense to you, read the PDF file and then contact whoever you think should be contacted. Your Senators and Representative are a good place to start. So might be these folks:
The Honorable Kathleen Sebelius
Secretary
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W. Washington, D.C. 20201
Toll Free: 1-877-696-6775
Donald Berwick, M.D.
Administrator
Centers for Medicare & Medicaid Services
7500 Security Boulevard Baltimore, MD 21244
Richard Gilfillan, M.D.
Director
Center for Medicare and Medicaid Innovation
Centers for Medicare & Medicaid Services
7500 Security Boulevard Baltimore, MD 21244
Teresa Nino
Director
Office of Public Engagement
Centers for Medicare & Medicaid Services
7500 Security Boulevard Baltimore, MD 21244
Jonathan Blum
Deputy Administrator and Director
Center for Medicare
Centers for Medicare & Medicaid Services
7500 Security Boulevard Baltimore, MD 21244
Sorry for bothering you with this but it’s rather dear to my heart. Also, this is not a slam at Medicare. I think their decision is a mistake. But it is a mistake that is correctable at a net savings to the taxpayer with a great benefit to many women.