The number of Medicare-eligible patients receiving a blood or marrow transplant has increased significantly. For the past several years, researchers and healthcare professionals throughout the world have worked hard to find innovative treatments to allow patients fighting a blood cancer or other blood disorder a way to receive a bone marrow, peripheral blood stem cell or cord blood transplant; which in many cases, is the only chance for a cure.
Yet, despite the increase in transplant referrals for Medicare beneficiaries, current Medicare reimbursement payment policy creates an unnecessary barrier for patients who need this potentially curative therapy.
Current Medicare payment policy
The Centers for Medicaid & Medicaid Services (CMS) provides a single Medicaid Severity – Diagnosis Related Group (MS-DRG 014) or Comprehensive observation service - Ambulatory Payment Classification (C-APC 5244) payment for inpatient and outpatient transplants. This payment is intended to cover the cost for the procedure, the inpatient stay (current average is 27 days) and all associated services, as well as the donor search and cell acquisition. Conversely, living kidney donor regulatory policy separates organ acquisition from the MS-DRG payment and compensates hospitals for reasonable expenses on a cost basis. Many services overlap between kidney and bone marrow transplants including typing, donor evaluation and transportation.
Transplant centers are losing thousands of dollars on each Medicare beneficiary they treat and some have decided not to perform bone marrow, peripheral blood stem cell and cord blood transplants on Medicare patients as a result of the inadequate reimbursement. The financial losses incurred by transplant centers to treat Medicare patients each year threatens the viability of blood and marrow programs and may result in serious access issues for Medicare beneficiaries. Patients who do not have access to transplant, will face expensive, likely futile alternative treatment options. In most cases, the lack of access to transplant will result in death.
Fortunately, Members of Congress are considering legislation that would require CMS separate payment for the cost of searching for donor and acquiring the cells used in transplant. This change would make reimbursement for bone marrow, peripheral blood stem cell and cord blood transplants on a reasonable cost basis.
Urge your Members of Congress to support legislation to reform Medicare payment policy for bone marrow, peripheral blood stem cell and cord blood transplants. Medicare beneficiaries need your help: be the voice to save a life!
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