Oncology groups are unhappy with the prospect that Medicare payments for chemotherapy drugs provided in outpatient settings could drop drastically in 2002. The Centers for Medicare and Medicaid Services (CMS) is considering a cut for what are termed "pass-through payments," because those payments—made for the most expensive and up-to-date drugs and medical devices—have increased above the 2.5% cap set by Congress as part of a new Medicare out-patient reimbursement system. Congress said that if pass-through payments rise above 2.5% of all ambulatory care costs, then the administrator of CMS must make reductions in those payments. Projections for 2002 show that pass-through payments could potentially reach 10%.
In a letter to Thomas Scully, administrator of the CMS, three members of the House Ways and Means Committee—two Republicans and one Democrat—complained about what they believe will be 60% to 80% reductions in Medicare reimbursements for that class of cutting-edge drugs. The three were Chairman Bill Thomas (R-Calif), Nancy Johnson (R-Conn), chairman of the health subcommittee, and Pete Stark (D-Calif), ranking Democrat on the health subcommittee. They argued that CMS should wait until April 1, 2002, before cutting payments for pass-through items such as chemotherapy drugs, and then only if the agency has come up with a better method of determining what the actual increase in pass-through payments has been. The Association of Community Cancer Centers (ACCC) is working with CMS and Congress to avert a precipitous decline in Medicare payments for chemotherapy agents. At press time, the ACCC intended to file written comments with the agency by October 3, 2001.
A 70-year-old man with a history of localized prostate cancer treated with whole-pelvis radiation therapy with a boost to the prostate, in conjunction with androgen deprivation therapy 7 years prior, presented with lower back pain. A bone scan revealed an area of activity in the sacrum. What is the most likely diagnosis?
