Investigation questions chemotherapy payments

Washington -- Extra Medicare payments many oncologists have been receiving since the beginning of the year have come under fire after a federal probe criticized them as duplicative.

At issue is a chemotherapy demonstration project that gives physicians an extra $130 per patient per treatment day in return for the doctors submitting information about the patients' levels of nausea, pain and fatigue. The Health and Human Services Dept. Office of Inspector General recently released preliminary details from a special investigation into the reimbursements that brings into question whether patients and taxpayers are getting their money's worth.

In a letter sent to Senate Finance Committee Chair Charles Grassley (R, Iowa), who requested the investigation, Inspector General Daniel Levinson described collection of patient data as incomplete and not uniform. Doctors are not required to use a standardized form to record patients' responses and have no script to follow when asking questions about chemotherapy's side effects, Levinson wrote.

Also, visits by the IG's office to several cancer clinics determined that Medicare is offering the added payment for a service that is already part of chemotherapy patients' routine care, he stated. The $130 is actually more than the average Medicare payment for the most complex office visit billed by oncologists, yet the questionnaire is often completed by nurses over the course of a few minutes, Levinson wrote.

Grassley seized on the latter point as evidence that the Centers for Medicare & Medicaid Services needs to alter the demonstration program if it is to continue beyond its expiration at the end of the year. Grassley said beneficiaries are charged $26, to help cover the government's cost, every time their doctors claim the payment.

"I am extremely troubled by the IG's preliminary findings regarding the project," Grassley wrote in a letter to President Bush. "It's unnecessary and fiscally irresponsible to require patients to pay for services that are already covered as part of their routine care."

Oncologists propose improvements

But allowing the demonstration to end after only one year would not allow doctors and patients to reap the benefits of the initiative, said Joseph Bailes, MD, an oncologist in Spring, Texas.

"The inspector general looked at this demonstration in isolation," he said. "There's no separate analysis of whether or not this reduced ER visits, reduced hospitalizations."

Providing an incentive for asking such questions of chemotherapy patients helps physicians focus on managing the symptoms of nausea, pain and fatigue that often accompany the cancer treatments, said Dr. Bailes, co-chair of the government relations committee at the American Society of Clinical Oncology.

ASCO has recommended several ways in which CMS can modify the program for renewal, including a requirement that physicians also report methods of treating the conditions so that the government can help determine which treatments work best.

Physicians have come to rely on the added payments, said Dr. Bailes, who is among the roughly two-thirds of oncologists who have claimed the additional funding.

CMS set aside about $300 million to launch the demonstration in part to lessen the financial blow of reducing payments to doctors for the cancer drugs themselves. And although beneficiaries help pay for a portion of the project funding, the lower drug charges mean that overall patient co-payments actually went down in 2005, he said.

"It is a vital part of the reimbursement," Dr. Bailes said. "Ensuring patient access to cancer care means appropriate payment for services."

Despite Grassley's concerns, House lawmakers issued a public show of support for the CMS demonstration nearly a month after the IG released its preliminary report to Congress.

By a voice vote, the House passed a resolution calling on the Medicare agency to extend the project through the end of 2006 after making any necessary modifications to improve the reporting element.