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Nation’s Transplant Centers and Advocacy Organizations Urge CMS to Address Underfunding of Cellular Transplant for Medicare Patients

Reforms needed to separate cellular acquisition and transplant payments in order to cover hospital costs and improve patient access to transplant procedures

June 13 2018

A groupof 26 transplant centers and advocacy organizations from across the UnitedStates today sent a letter to the Centers for Medicare & Medicaid Services(CMS), pushing for changes to the payment policy for bone marrow, peripheralblood stem cell, and cord blood transplants that would allow hospitals to carefor transplant patients without facing significant financial obstacles. 

Acrossthe country, there are more than 1.2 million people living with—or in remissionfrom—blood cancers such as leukemia, lymphoma and myeloma. Every three minutesa new patient in the United States is diagnosed with a blood cancer. For manyof these patients, a bone marrow or cord blood transplant is their only hope fora cure. In this context, a coalition of transplant centers and advocacyorganizations across the country has submitted a letter to CMS in order toaddress the critical underfunding of bone marrow and cord blood transplants forthe Medicare population. The coalition’s organizations represent the bonemarrow, peripheral blood stem cell and cord blood transplant communities thatwork to facilitate what is often the only curative option available forpatients.

Thecoalition’s letter addresses CMS’ proposed rule entitled, “Medicare Program; Hospital InpatientProspective Payment Systems for Acute Care Hospitals and the Long-Term CareHospital Prospective Payment System and Proposed Policy Changes and Fiscal Year2019 Rates.” The coalition argues Medicare’s current payment policy has createdunnecessary barriers to accessing cellular transplant because Medicarecurrently only provides a single, inadequate MS-DRG payment for inpatient transplantthat is inclusive of donor search and cell acquisition charges.

Due to this underfunding,hospitals are often left with very few dollars from the MS-DRG payment withwhich to pay for the long, inpatient, post-procedure stay. Specifically, theFY2018 base payment rate for MS-DRG 014 (Allogenic Bone Marrow Transplant) is $69,844,while the average cost of acquiring adult donor cells and peripheral blood stemcells is $49,426 and $64,864 for cord blood in the same year. After obtainingthe cells, hospitals are being asked to provide high intensity care for 27 days(average inpatient stay length) for patients for $20,000 or less.     

Clearly, as notedin the coalition’s letter to CMS, the lack of sufficient funding for cord bloodand marrow transplants puts hospitals in an impossible position that endangerstheir commitment to providing their patients with high-quality care and reducespatient access to life-saving procedures. Because the current reimbursementrate barely covers (and often does not fully cover) the cost of cellacquisition, hospitals are facing tremendous financial losses.

The letter furtherargues that CMS should reduce barriers to accessing transplants by parallelingsolid organ transplant reimbursement by adopting the same payment policy forcellular transplant. The coalition advocates for separating the costs of cellacquisition from the current MS-DRG payment, meaning CMS would pay for cellacquisition on a reasonable cost-basis (as it does for other solid organacquisition costs) that would allow hospitals to accept cellular transplant patientswithout undergoing financial hardship.

In addition tourging CMS to protect the Medicare population’s access to life-saving cellulartransplant through the regulatory process, transplant centers also support alegislative solution to this funding shortfall through H.R. 4215, the Protect Accessto Transplant (PACT) Act.