The esteemed Senator from Iowa recently lambasted cancer doctors for devising a nefarious program to enrich the already rich via a chemotherapy study. The Inspector General found Medicare’s study to be poorly designed and implemented.
In November 2004, Dr. Mark McClellan bragged about this innovative study.
“We are working with the National Cancer Institute, oncologists, and the cancer community to develop better evidence to design the best possible treatment decisions for our beneficiaries. There are too many unanswered questions in cancer care today fro seniors and people with disabilities, and Medicare will help develop more practical evidence to improve care.”
Some suggest the $300 million paid to oncologists for participating in the study helped make up for an estimated $500 million decrease in their Medicare reimbursement to private oncology offices that provide chemotherapy services for 2005. This could be the reason Senator Grassley blames “greedy physicians”.
I reviewed some of the Medicare communication to physicians’ offices on the study and found several concerns. The document specifically says “we are not mandating a specific approach to collect the data”. It could be collected by the physician or a member of their office staff. While Medicare wants clinical information, it does not specify a clinician collect the information.
My other concern is in regard to the lack of operation definitions for the measures of interest, nausea, pain, and lack of energy. Under each area patients self report "not at all", "a little", "quite a bit", or "very much". This data is subjective and responses will vary by patient with no clarification as to the difference between a little and quite a bit or very much. Were Medicare truly interested in this data, they would have given the patient a log book to record the patient’s experience on all three measures throughout the course of treatment. Definitions would be included that aided the patient in accurately recording their experiences.
That a demonstration project could be so poorly planned and executed is disturbing enough. That it’d been intended as a bribe or a pain reduction strategy is even more discouraging. What does that portend for the Bush administration’s big quality push? Are huge payment reductions just around the corner? With the Bush plans to cut reimbursement for pacemakers is a big cardiac study on its way?
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