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New cancer treatment coverage plan unveiled by Medicare

Ambulatory Surgery Reimbursement Update, November 9, 2004

The October 19 issue of Ambulatory Surgery Regulatory Update contained a story about the proposed Medicare cuts to the physician fee schedule that would affect oncologists. Last week, however, CMS announced some changes for 2005 likely to offer at least some consolation to those physicians and their patients undergoing cancer treatment.
 
According to a story on the online news service BestWire, CMS issued a November 1 announcement that indicated they would, in 2005, expand their coverage of clinical trials for new cancer drugs, offer financial incentive for physicians to monitor their patients' reaction to these new drugs, and pay for positron emission tomography (PET scans) for cervical cancer.

The new clinical trial coverage will apply to participants in a series of nine upcoming studies sponsored by the National Cancer Institute. The studies will involve a number of colorectal drugs, including oxaliplatin, irinotecan, bevacizumab and cetusimab, and will explore the "off-label" use of these drugs in treating other forms of cancer.

The financial incentive program will offer doctors $130 per patient per visit, and will see doctors measuring symptoms of pain, nausea and vomiting, and fatigue suffered by patients in response to different drug treatments. The purpose of the study, according to Medicare, is to "assess a cancer patient's status in these important dimensions of quality of life."

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