Medicare cuts endanger hemophilia sufferers.

• Author: Elliott, Jeff
• Position: Medicine & Health - Brief Article

THE PRESCRIPTION DRUG and Medicare Improvement Act of 2003 has one major flaw--reimbursements on medical supplies and home health care. The problem is that legislators are embracing a new reimbursement model without fully understanding its impact on the hemophilia community. With the new higher cost of care items, patients will not have access to critical home care services, which will delay necessary treatment.

In terms of treatment, hemophilia is the fifth most costly chronic disease. At present, the in-home health care industry saves hospitals thousands of dollars per patient per year Medicare Act reimbursement cuts, however, will drive individuals with hemophilia into hospitals and emergency rooms at a much greater cost to the system. With lifesaving home care services out of roach, interminable treatment delays will drive up the frequency of crippling episodes and fatalities as well as heap additional expenses on the Medicare system. If this sounds overly dramatic, talk to the thousands of individuals throughout the U.S. who have hemophilia for whom this legislation could be a matter of life and death.

According to Jonathan Goldsmith, president of the Immune Deficiency Foundation and former director of several hemophilia treatment centers: "People with hemophilia need access to their life-saving factor in a timely fashion, and if they don't receive prompt treatment at the first sign of bleeding--which is often in a home setting--then they will have problems that include progressive joint damage and bleeding into vital areas that could have very serious health consequences."

"We have been fighting a reimbursement nightmare for the past three years," relates Jan Hamilton, executive director of the Hemophilia Federation of America. "If people with hemophilia can't continue to get their product at home, and they have to go back to the emergency room or the doctor's office or the hospital to get it, we've just lost 20 years of progress."

At issue is a significant restructuring of the core reimbursement methodology used by Medicare for the biological blood dotting "factor" patients require to prevent or stein bleeding episodes. The Medicare Act outlines a shift from the current reimbursement rate of 95% of the Average Wholesale Price (AWP) per unit to a calculation based on Average Sales Price (ASP) plus a nominal administration tee. By all accounts, this represents a dramatic reduction in the amount of reimbursement that provides for blood clotting factor and a few ancillary supplies. Moreover, it leaves little else to cover a host of services that...