The Morning Report provides a quick look at today’s medical news, research and features.
|Should Bone Marrow Donors Be Paid?
The federal government’s proposal to ban compensation for a specific method of bone marrow donation has drawn heated responses from both supporters and opponents. The Health Resources and Services Administration (HRSA) in October proposed making circulating bone marrow stem cells a human organ, which would thereby outlaw payments to donors.
The controversy stems from the way in which the bone marrow is collected. Traditionally, a needle is inserted into bone marrow to extract liquid containing hematopoietic stem cells (HSCs). It is these cells that are transplanted to recipients after filtration. Compensation for people who donate under this method is already banned under the National Organ Transplant Act of 1984 (NOTA), which outlaws the compensation of donors of human organs; violators risk a fine of up to $50,000 and 5 years in prison. The law’s definition of organ includes “bone marrow … or any subpart thereof.”
However, under a method called peripheral blood cell apheresis, donors receive injections to stimulate HSC production. HSCs are collected via an apheresis machine from donors’ central veins before the remaining blood is returned.
Some groups, including a nonprofit called MoreMarrowDonors.org, wanted to award scholarships, housing allowances, or gifts to charity for bone marrow donors who donated using the apheresis method. Various advocates of such compensation, including parents of children with leukemia and aplastic anemia, filed a preemptive lawsuit, saying that NOTA’s ban on compensation was unconstitutional if it were to be applied to apheresis.
They lost in the lower courts, but in March 2012, the Ninth Circuit Court of Appeals agreed with the plaintiffs, holding that donors could be compensated if the apheresis method is used. As a result, HRSA has now proposed changing the definition of “bone marrow” so that the compensation ban doesn’t hinge on the collection method. The American Society of Hematology (ASH) and the American Society for Histocompatibility & Immunogenetics (ASHI) have said they believe that paying for donations may interfere with what’s clinically best for the patient and may raise concerns about what’s best for the safety of patients and quality of care.
|Prostate Cancer Combo Treatment Provides Better Survival Rate|
Men with advanced prostate cancer survived significantly longer on a combination of two types of drugs than if they were started on the standard single treatment, according to a major federally sponsored study, which researchers suggested should change the way many such patients are treated.
The treatments involved hormone therapy to suppress levels of testosterone, the natural fuel for prostate tumors, and the chemotherapy docetaxel. Conventional practice has been to start men on testosterone suppression and then try docetaxel chemotherapy once the cancer progressed, said Christopher Sweeney, a medical oncologist at the Harvard-affiliated Dana-Farber Cancer Institute in Boston and lead investigator for the study.
But the 790-patient trial, which began in 2006, found that 69% of men who started with the combination therapy were alive after three years, compared with 52.5% who were started on hormone therapy alone, researchers said Thursday. The survival advantage, determined in a recent interim analysis of the study by an independent safety committee, was so striking that officials at the National Cancer Institute decided to release the finding early before a full analysis of the trial was completed. The NCI, part of the National Institutes of Health, funded the study.
“The data point was so strong and clear and accurate we feel confidence releasing this” for patients and clinicians to consider in treatment decisions, Dr. Sweeney said. The interim analysis also showed that men with particularly advanced disease-those whose cancer had spread to at least four different locations in bone or had spread to a major organ such as the liver-were the most likely to benefit from the combination treatment, the NCI said. (WSJ)
|Is This A Fair Way To Pay Docs?|
The Affordable Care Act, ACOs, and the inflationary effects of fee-for-service payments have led to a resurgence in the use of capitated payment methodologies. Providers should have a good understanding of what capitation is, and what risks are inherent.
A capitated agreement is essentially a risk management agreement. Just as a gambler would contemplate the risks inherent with each wager, the physician, too, should engage in a similar decision making process when determining whether to participate with a capitated plan.
To determine if the capitated payment adequately compensates the provider for the risk assumed, the provider needs to have the information necessary to make an informed decision. The insurance carrier should be asked to provide utilization data. The provider should have a fundamental understanding of what constitutes a fair per-patient encounter reimbursement; the capitated plan’s anticipated utilization based on historical data; the anticipated number of Members that will be assigned to the provider; and the anticipated PMPM (per member, per month) and copayment amounts for the Members in the plan. The provider needs to have a clear understanding of the practice’s operational metrics and should be able to anticipate how an influx of capitated patient volume could affect the practice’s bottom line. (Full text at Physicians News)