Legislation would eliminate Medicare payment barrier to only curative therapy option by aligning bone marrow, peripheral blood stem cell and cord blood transplant reimbursement with Medicare payment policies used for solid organ transplant
-- November 07 2017
WASHINGTON – National Marrow Donor Program® (NMDP)/Be The Match® today announced its strong support for H.R. 4215, which would adjust reimbursement for hospitals that provide bone marrow, peripheral blood stem cell (PBSC) and cord blood transplants (cellular transplants) to Medicare beneficiaries. The policy change addresses critical under-reimbursement that has caused many hospitals to question their ability to provide the only curative treatment for blood cancers and other blood disorders to Medicare beneficiaries.
“We commend Representatives Eric Paulsen (MN), Ron Kind (WI), Gus Bilirakis (FL) and Doris Matsui (CA), for introducing this bipartisan legislation that will ensure access to blood cell transplants for Medicare beneficiaries with blood cancers or other blood disorders, for which transplant is the only potentially curative treatment option,” C. Randal Mills, Ph.D., CEO of NMDP/Be The Match said. “By introducing legislation that will reimburse hospitals for the cost of acquiring bone marrow, PBSC and cord blood cells the same way solid organ acquisition costs are paid, Congress is ensuring that Medicare patients who might otherwise die from their disease have access to necessary treatment.”
Under current payment policy, Medicare uses a single Medical Severity Diagnosis Related Grouping (MS-DRG) to reimburse hospitals for cellular transplant, which includes both the 20 to 30-day hospital stay and the cost of cell acquisition. Although the current Medicare inpatient base reimbursement rate is $62,245, the cost of cell acquisition can utilize a significant portion of reimbursement leaving little available for patient care. Conversely, hospitals that provide solid organ transplants are paid for the organ acquisition cost separately from reimbursement for related inpatient care through an MS-DRG.
The science behind transplant has advanced dramatically over recent years, allowing physicians to treat an increasing number of Medicare beneficiaries with blood cancers such as leukemia, myelodysplastic syndromes and lymphomas; bone marrow failure disorders such as aplastic anemia and immunodeficiency syndromes; and genetic diseases such as sickle cell disease. Yet, as more patients seek transplant as the only life-saving option to treat their disease, hospitals cannot afford to write off the significant losses they incur from the current reimbursement rate for Medicare beneficiaries. In fact, some hospitals have decided not to expand their transplant programs to accommodate the growth represented by the Medicare population.
“While approximately 1,200 Medicare beneficiaries received cellular transplants last year, the need is much greater,” Mills said. “A major barrier to Medicare recipients getting access to a life-saving transplant is the lack of appropriate reimbursement. With this legislation, we begin to reduce this barrier, therefore allowing more patients to be cured of their disease and return to their families and friends. By adequately reimbursing hospitals for patient care and separating out cell acquisition costs, like the precedent set by solid organ transplants, we can eliminate the disparity facing our Medicare recipients.”
About Be The Match
For people with life-threatening blood cancers—like leukemia and lymphoma—or other diseases, a cure exists. Be The Match® connects patients with their donor match for a life-saving marrow or umbilical cord blood transplant. People can contribute to the cure as a member of the Be The Match Registry®, a financial contributor or a volunteer. Be The Match provides patients and their families one-on-one support, education and guidance before, during and after the transplant.
Be The Match is operated by the National Marrow Donor Program® (NMDP), a nonprofit organization that matches patients with donors, 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. To learn more about the cure, visit BeTheMatch.org or call 1 (800) MARROW-2.