Medicare, cover seniors’ stem-cell transplants

In the mid-1980s, Congress established a national marrow registry to help individuals with blood cancers — like leukemia, myelodysplastic syndromes, multiple myeloma and lymphoma — and other diseases find a matching bone marrow or umbilical-cord blood donor to help cure their disease.

This bipartisan effort during the past 30 years has given almost 70,000 transplant recipients a second chance at life. Because of this success, Republicans and Democrats in both the U.S. House and Senate joined together in December to reauthorize this important program.

Despite this overwhelming support, a small group of Americans in need of a life-saving stem-cell transplant — those 65 and older — have seen their treatment options limited by inadequate Medicare payment and coverage rules, just as medical advances have shown that these transplants offer the same hope of a cure for those over 65 years old as for younger patients. These findings are so compelling that the federal government needs to reaffirm its commitment to the health of all Americans. Patients in need of a life-saving marrow or cord-blood transplant who rely on Medicare need to have the same access to care as Americans who rely upon private insurance.

Over the past decade, medical advances have allowed stem cell transplant centers —such as the Sylvester Comprehensive Cancer Center in Miami — to treat infants, and patients well into their 70s, with life-saving transplants for nearly 70 different diseases. For those under age 65, private insurance generally covers marrow and cord blood transplants for all 70 diseases, yet something unnerving takes place as older patients transition to Medicare; for the vast majority of these diseases, Medicare will only determine whether or not a transplant will be covered after it is performed. If Medicare determines that the procedure — which is often the patient’s only chance for a cure — is not covered, the beneficiary becomes responsible for all transplant costs.

Even when Medicare does cover the transplant, the federal reimbursement rates fall far short of the cost of providing transplant care. Unlike for solid organ transplants, Medicare does not cover the full costs of procuring the bone marrow or cord blood that is needed in order to perform the transplant. Hospitals report reimbursement that is, on average, 47 percent below the actual costs of providing care, amounting to typical losses of $40,000 per transplant.

There is a practical and simple solution. The Centers for Medicare & Medicaid Services (CMS) can expand coverage for marrow transplantation under Medicare, and it can start to treat bone marrow and cord blood procurement like it does solid organ procurement, and pay for the search and procurement costs directly. This change would not only provide access to transplant services, but it would eliminate the uncertainty and stress created under the current Medicare system rules.

Medicare beneficiaries should not have to worry about whether transplant is covered or if their hospital stay for transplant will be fully covered. Everyone is at risk of getting a blood cancer; now’s the time for all of our voices, including doctors, patients, family members and advocates together, to reverberate around the halls of Washington, and get action.

Dr. Krishna Komanduri is the director of the Sylvester Adult Stem Cell Transplant Program, University of Miami Health System.

This story was originally published May 26, 2016 at 6:17 PM with the headline "Medicare, cover seniors’ stem-cell transplants."