The Evidence Gap - Geography Has a Role in Medicare Cancer Coverage - NYTimes.com

[Guest guest]

The disparities result from a policy principle as old as Medicare itself, in which officials in Washington leave many reimbursement decisions to the discretion of 15 regional contractors around the country. A dozen of them willingly pay for CyberKnife treatments among other prostate options. But three of the regional contractors have balked at covering CyberKnife, saying there is not enough evidence of its long-term effectiveness against prostate cancer.

Many health policy experts applaud refusing reimbursement for treatments not supported by medical evidence. But some also point to CyberKnife as emblematic of the inconsistent way that the federal Medicare budget — expected to be $477 billion in the current fiscal year — is spent, region to region.

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The three Medicare contractors that have declined to cover CyberKnife for prostate cancer are TrailBlazer Health, Palmetto GBA and Noridian Administrative Services. The affected states are Alaska, Arizona, California, Colorado, Hawaii, Montana, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Texas, Utah, Vermont, Virginia, Washington and Wyoming.

snip

The board of the radiation oncology society, the American Society for Therapeutic Radiology and Oncology, or Astro, has called CyberKnife promising, but raised questions this year about the evidence supporting its use in prostate cancer, saying “there is not sufficient or mature data to demonstrate equivalency to existing standard treatment modalities.” The statement also applied to other brands of the technique, which is known as stereotactic body radiation therapy.

Citing the variety of proven treatments for prostate cancer, one member of the Astro board, Dr. Louis Potters of North Shore-Long Island Jewish Health System, said that advertising CyberKnife directly to consumers could confuse patients, who have to choose the best treatment from an already bewildering array of options.

“Patients are becoming commodities and prostate cancer is the ultimate example,” Dr. Potters said.

To read the entire article:

http://www.nytimes.com/2008/12/17/health/policy/17knife.html?_r=2 & scp=1 & sq=cyberknife & st=cse

or

http://tinyurl.com/42ek2l

Kathy

[Guest guest]

> The disparities result from a policy principle as old as Medicare

> itself, in which officials in Washington leave many reimbursement

> decisions to the discretion of 15 regional contractors around the

> country. A dozen of them willingly pay for CyberKnife treatments among

> other prostate options. But three of the regional contractors have

> balked at covering CyberKnife, saying there is not enough evidence of

> its long-term effectiveness against prostate cancer.

I have no axe to grind re: " CyberKnife " , though I have divergent opinions.

My point is that there are indeed differences between Medicare regions.

I have the warm pleasure of residing in Arizona. A few years ago, I was

informed that a certain procedure would not be covered by Medicare. I

learned that the procedure *was* covered in California, a couple hundred

miles, a different contractor, and the Colorado River to the west.

I was preparing to trot over the river and have the procedure done in

California when I was informed that the folks in charge of my region had

awakened and approved it.

Take-home lesson for those on Medicare: Check around the adjoining

Medicare regions if your preferred procedure is denied.

Regards,

Steve J