Congress: make marrow transplants accessible for older Americans

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For people with leukemia, lymphoma and other blood diseases, there is good news. Bone marrow transplants are saving lives—often curing these life-threatening illnesses. Unfortunately, out of date Medicare coverage rules are restricting access to bone marrow transplants solely on the basis of age. Hence, a patient who is 64 years old will likely receive a much-needed transplant, while a 65-year-old may not. Determining who is eligible for this life-saving treatment should not be done by arbitrary age requirements. Lawmakers need to change this illogical age cut off and let doctors decide who should be a candidate for a bone marrow transplant.

Just 30 years ago, a bipartisan coalition of lawmakers came together to improve care for people with blood cancers, establishing a national bone marrow registry. The move was revolutionary. Before the registry, it was next to impossible to connect with a matching donor who was willing to donate his marrow for transplant unless a family member was a good match. The registry, known as the Be The Match Registry and operated by the National Marrow Donor Program, connects millions of donors and recipients resulting in nearly 74,000 life-saving transplants since the mid-1980s.

{mosads}As technology continues to improve, transplants have become increasingly successful—something something I have personally witnessed over the course of my professional career. We are using bone marrow transplants to treat more than 70 diseases and conditions in infants and seniors alike. Private insurers have taken note of these life-saving and state-of-the-art treatments and are covering marrow and cord blood transplants in almost all cases. However, the same cannot be said about Medicare, which only covers transplants for only a handful of conditions. The discrepancy between private and public insurance is inappropriate. So are Medicare’s reimbursement policies.

For the vast majority of diseases and indications for which transplant is an option, Medicare will only determine whether or not a transplant will be covered after the procedure is performed. This means that if the government—for whatever reason—determines that the transplant is not needed, the patient is forced to absorb the costs. The uncertainty of looming medical bills may discourage patients from transplants and the health consequences could be catastrophic. Even patients over the age of 65 who are eligible for transplants face other major obstacles.

Restricted access from the patient perspective is augmented on the supply side of care. The government currently reimburses hospitals that perform bone marrow or cord blood transplants at about 47 percent below the actual cost of care (as opposed to solid organ transplants, which are paid for in full). As a result, care facilities are now reporting average losses of $40,000 per transplant performed on Medicare patients. Naturally, it follows that many hospitals could start scaling back operations and treat fewer patients.  As someone who was worked for more than 25 years helping blood cancer patients, this is simply unacceptable.

Consider this: The U.S. Department of Health and Human Services estimates that nearly 20,000 people in America could benefit from a life-saving marrow or cord blood transplant each year.  Policymakers should be working tirelessly to expand access to necessary services, rather than making it more difficult for Americans over the age of 65 to access care. The good news is that there is a simple solution.

First, the Centers for Medicare & Medicaid Services (CMS) should express their commitment to patients with blood cancers and other blood disorders, starting with expanding coverage for marrow transplant under Medicare, as private insurers have already done. Second, CMS should reimburse hospitals at rates that recognize the cost of providing transplant services, as well as pay directly for the search and procurement costs, as it already does for solid organs. Both moves would benefit patients and the care delivery system.

Finally, the hematopoietic cell transplantation community has been in the forefront for developing strategies that will guarantee the best quality of care for patients with blood cancers, from the development of standards of accreditation through the Foundation for Accreditation of Cellular Therapies, to the obligatory reporting of outcomes to the Stem Cell Transplantation Outcomes Database through the Center for International Research in Blood and Marrow Transplantation. Hematopoitic cell transplantation has been shown to be the most effective therapy for many patients with blood cancers, and we should do everything in our power to enhance access to this lifesaving procedure.

Arbitrary coverage rules and anemic funding for transplants should make our nation’s lawmakers sit up and take notice. As increasing numbers of Baby Boomers continue to join the Medicare system, those over 65 are the ones who will most likely need bone or cord blood transplants. In the end, lawmakers must make sure the best possible treatments are equally available to all, regardless of one insignificant number: their age.

Sergio Giralt, MD is the Melvin Berlin Family Chair in Myeloma Research; Professor of Medicine at Weill Cornell Medical College and Chief Attending, Adult BMT Service, Memorial Sloan Kettering Cancer Center.


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