Fall in Hospital Incomes Hurts Clinical Trials

BETHESDA, Md-Robert W. Day, MD, told fellow members of the NationalCancer Advisory Board (NCAB) that a brief survey he sent to teachinghospitals across the country showed that reimbursement per casehas dropped, and the likely culprit is managed care.

"The profit margin that was used to support training andclinical research is now gone," said Dr. Day, president anddirector, Fred Hutchinson Cancer Research Center, Seattle, "andthe single biggest payer in the country, Medicare, has an exclusionagainst anything experimental, including clinical trials. Thatneeds to change."

Although the survey showed no recent change in the number of patientsgoing into clinical trials, a crisis may be impending.

Dr. Frederick F. Becker, vice president for research and scientificdirector, The University of Texas M.D. Anderson Cancer Center,said that the city of Houston has had 25% penetration by managedcare and that the income of his hospital has already fallen byalmost that amount.

This reduction in income will negatively affect the dollars availablefor clinical research, Dr. Becker said, adding that "it isonly a matter of time before clinical research will be in crisis."

In California, the money paid per patient in clinical trials hasdropped by 34%, said Dr. Charles Wilson, director, Universityof California, San Francisco Neurosurgery Brain Tumor ResearchCenter.

"We have done a poor job of selling clinical trials to insurersand managed care plans," Dr. Wilson said. "The beststandard treatment for a cancer patient may be a trial,and that needs to be made clear to insurance companies."