Cancer patients, make sure you don’t get conned

The Cruelest Con

You know those movies where the bad guy is defeated, but then–AHHH!–he pops up and the mayhem starts all over again?

That’s what happened with chemotherapy concession.

And if you don’t know what chemotherapy concession is, prepare to be enraged twice–once for what it is, and again for its new lease on life at the expense of vulnerable cancer patients and their families.

When more is less

I call it “chemo con” because in many cases it’s nothing less than a huge con.

Here’s how it works…

An oncologist purchases chemotherapy drugs directly from drug companies, then bills the patient’s insurer.

Here’s the catch: Oncologists typically get a deep discount off the “sticker” price of the drugs. Then they bill insurers for the sticker price, which is sometimes more than 20 percent higher than the amount paid by the doctor.

But that’s not the con. In fact, this practice is completely legal and considered a “concession” to offset oncologists’ overhead. The con occurs when an oncologist uses a chemo drug that he knows will not be effective, or administers it to a patient he knows will get no benefit.

And that happens. A LOT.

A few years ago, an oncologist examined the medical records of almost 8,000 cancer patients. He found that in cases where chemo was given in the final six months of life, ONE- THIRD of the patients had cancers that are known to be unresponsive to chemotherapy.

Angry? Me too. But hold onto your hats. It gets worse.

In 2005, the Medicare Modernization Act curbed chemo concession claims. Under the new plan, Medicare reimburses no more than 6 percent over the average amount doctors pay for any individual chemo drug. (Of course, this has no effect at all on the billing for patients not covered by Medicare.)

Experts were concerned that this would result in less care for cancer patients who relied on Medicare.

Not to worry, fellas!

After new the rules took effect, the total number of Medicare claims for chemo treatments given within one month of diagnosis didn’t drop, they increased by nearly 2.5 percent. In addition, the use of less expensive chemo drugs declined, while the use of more expensive drugs increased.

In other words, crank up the chemo and keep those coffers full!

But those profits come with a sacrifice–a sacrifice by patients, that is.

In a 2008 review of about 600 cases in which cancer patients died within 30 days of receiving chemo, 40 percent experienced “significant poisioning” from their treatment, and about one-in-four deaths were accelerated or actually caused by the treatment.

Every cancer patient and their family needs to be aware of chemo con. If a doctor prescribes chemo–especially in the very late stages–it’s time to start asking as many questions as possible to make sure the con isn’t on.

To Your Good Health,

Jenny Thompson

Sources:
“How Medicare’s Payment Cuts For Cancer Chemotherapy Drugs Changed Patterns Of Treatment” Health Affairs, Published online ahead of print 6/17/10, content.healthaffairs.org
“Medicare Cuts May Have Led Docs to Prescribe More Chemo” HealthDay News, 6/17/10, consumer.healthday.com
“Medicare Cuts Increase Cancer Treatments, Study Finds” David Cameron, Harvard press release, 6/17/10, hks.harvard.edu