Medicare coverage woefully underfunds cell acquisition for bone marrow and cord blood transplants.

-- August 10 2016

The National Marrow Donor Program® (NMDP)/Be The Match®, which operates the nation's Be The Match Registry® of potential adult volunteer marrow donors and donated umbilical cord blood units, today expressed disappointment that the Centers for Medicare & Medicaid Services (CMS) did not establish policy changes to address the deficits marrow and cord blood transplant centers incur for the cost of acquiring the cells used in transplants in the final hospital inpatient prospective payment system (IPPS) rule for CY2017.

"We are disappointed that CMS does not address chronic underfunding of bone marrow and cord blood transplants for Medicare beneficiaries in the inpatient setting, where the majority of these life-saving transplants occur," said Jeffrey W. Chell, M.D., chief executive officer of the NMDP/Be The Match. "These transplants are often the last therapeutic option patients with a blood cancer or other blood disorder have and the only chance for a cure.  We had hoped CMS would have included a way to ensure that the reimbursement rate does not create a barrier to access in the final rule."

NMDP/Be The Match urges CMS to find a way to address this problem in the inpatient setting without waiting until next year. The NMDP/Be The Match, along with the American Society of Blood and Marrow Transplant, cord blood banks, transplant centers, and patient advocates have asked CMS to reimburse hospitals for the cost of acquiring cells for transplant using the same method Medicare relies upon to reimburse hospitals for the cost of acquiring solid organs.  Medicare currently pays solid organ acquisition costs for kidney, heart, heart-lung, liver, lung, pancreas, and intestinal (or multivisceral organs) transplants on a reasonable cost basis and separate from the prospective payment rate.

Despite the lack of a solution in the final inpatient hospital payment rule, the NMDP/Be The Match remains hopeful that the problem will be addressed in the hospital outpatient setting. The HOPPS proposed rule, on which CMS is still seeking comments, would adopt a new method for determining the payment amount for bone marrow and cord blood transplants that would better account for the cost of acquiring these cells. Even though the vast majority of transplants occur in the inpatient setting, there are a limited number each year that can be successfully performed in the outpatient setting.

"While we were encouraged when CMS chose to increase cell acquisition and transplant rates in the outpatient setting, which we applauded as a first step toward improving care and recognizing the acute underfunding for procurement and transplant for the outpatient setting, we are puzzled as to why CMS neglected to take a similar positive step forward for the inpatient setting, which is where most transplants occur since hospital stays are often required," Chell added.  "We are deeply concerned that for another year hospitals will be expected to perform transplants without adequate reimbursement, as the costs exceed the amount Medicare will pay them. This disconnect between cost and reimbursement rates places tremendous strain on our nation's transplant programs and seriously threatens access for Medicare patients in need of transplant for survival."

About the National Marrow Donor Program® (NMDP)/Be The Match®

The NMDP/Be The Match is the global leader in providing a cure to patients with life-threatening blood and marrow cancers such as leukemia and lymphoma, as well as other diseases. The nonprofit organization manages the world's largest registry of potential marrow donors and cord blood units, connects patients to their donor match for a life-saving marrow or umbilical cord blood transplant, educates health care professionals and conducts research through its research program, CIBMTR® (Center for International Blood and Marrow Transplant Research®),so more lives can be saved. NMDP/Be The Match also provides patient support and enlists the community to join the Be The Match Registry®, contribute financially and volunteer.