Despite the passage of health care reform legislation last week, Congress failed to approve a $138 billion bill to prevent a planned 21% cut in Medicare Part B reimbursements to physicians before entering its spring recess. The cuts are set to go into effect on Thursday, April 1st. Although the Senate earlier this month approved a measure to prevent the cuts from taking effect until October 1st, the House failed to pass the measure before Congress began an approximately two-week long recess that will delay a fix from being passed until at least mid-April.
The bill is the most recent in a series of yearly postponements in cuts to physician payments prescribed by the sustainable growth rate (SGR) formula. Developed to ensure that Medicare spending doesn't outpace growth in the economy, the SGR is an accounting mechanism which ties Medicare Part B reimbursement rates to the gross domestic product. The formula has called for large cuts in physician payments every year since 1997. However, successful annual lobbying efforts by the American Medical Association and other physician groups have persuaded Congress to postpone these cuts each year, arguing that reducing reimbursements would cause doctors to stop seeing Medicare patients, jeopardizing access to healthcare for millions of seniors and military families. Such cuts, they argue, would reduce payments to well below the cost of providing care.
Physicians have advocated for the repeal of the SGR method, rather than perpetual reliance upon Congress to take action each year. Negotiations on a permanent fix have been active since December, but an initial vote was taken to postpone the planned decreases from January 1st until April 1st to allow Congress more time to develop a permanent solution. However, with Congress now in recess, a vote by the House to further forestall the cuts beyond April 1st will not be possible until their return in mid April, without which the -21% decrease in reimbursement rates will take effect.
Congress' failure to act before the April 1st deadline may be partially attributable to the looming fate of the overall health care reform package, which some had feared might complicate the delicate political process involved with that bill's passage. Now unhampered by activity on that legislation, the House of Representatives is widely expected to pass their version of the Senate's postponement bill (which also includes provisions on extending COBRA and unemployment benefits) upon returning to Capitol Hill two weeks from now. While this will result in at least a brief period of temporarily reduced Medicare physician payments, it is likely that -- when passed -- the House bill will apply the postponement of rate decreases retroactively to April 1st, ensuring all claims filed between the 1st of April and the date the bill takes effect will be reimbursed at the pre-cut rates.
Among the studies presented at the Society of Interventional Radiology's (SIR) 35th annual scientific meeting last week, one lends an encouraging development in the use of interventional oncology therapies for prolonging the life of liver cancer patients and minimizing side effects associated with traditional treatments. The study, led by Dr. Riad Salem, director of interventional oncology at the Robert H. Lurie Comprehensive Cancer Center at Northwestern Memorial Hospital in Chicago, tested the use of intra-arterial yttrium-90 (Y-90) radioactive isotope therapy to deliver a high dose of radiation directly to liver tumors. When compared to traditional treatment methods, this use of Y-90 to deliver a higher dose of targeted radiation showed promise for prolonging life and decreasing adverse side effects experienced by liver cancer patients.
The study consisted of 291 hepatocellular carcinoma (HCC) liver cancer patients, each treated with an average course of 1.8 Y-90 microspheres. Microspheres were inserted through a catheter into the liver artery supplying each tumor. Each isotope then provided localized "internal radiation" within tumor vessels, spurring cell death. Researchers evaluated patient response to the treatment, as well as time-to-progression, and survival rates by different cancer stages.
Study Lends Further Support to Role of Selective Internal Radiation Therapy for Prolonging Life of Liver Cancer Patients
My colleague, Charlie Robinson, has been involved in a new terrain of reserach for our research group, looking at developments being made in stem cell research and their potential applications in medicine moving forward. He's been finding some particularly interesting topics and I wanted to share one in particular.
In February 2009, a German medical team may have cured a patient's HIV infection while treating his leukemia. The patient--a 42-year old American living in Germany--is still without signs of HIV infection two years after receiving a bone marrow stem cell transplant. Physicians deliberately chose a donor with a naturally occurring gene mutation that confers resistance to most types of HIV infection--a mutation known at CCR5--which is normally found on the surface of T cells, the type of immune system cells attacked by HIV.
Though physicians assert that stem cell transplants are not a feasible routine treatment option for HIV--explaining that about one third of patients die from such transplants--the findings are promising for the future of HIV therapy. A more reasonable approach based on these findings would be a type of CCR5-disabling gene therapy or treatment that could be injected directly into the body. Experts predict this type of treatment could be available within the next five years.
While the findings in this case represent a glimmer of hope for patients living with HIV, physicians note that it is unlikely that the transplant completely eradicated HIV from the patient's body. Moreover, German physicians who performed the transplant procedure admit, "There is no really conclusive explanation why [they] didn't observe any rebound of HIV. This finding is very surprising."