Investigation questions chemotherapy payments

Oncologists vow to work with CMS to improve the Medicare demonstration project.

By David Glendinning, AMNews staff. Nov. 7, 2005.

Washington -- Extra Medicare payments many oncologists have been receiving since the beginning of the year have come under fire after a federal probe criticized them as duplicative.

At issue is a chemotherapy demonstration project that gives physicians an extra $130 per patient per treatment day in return for the doctors submitting information about the patients' levels of nausea, pain and fatigue. The Health and Human Services Dept. Office of Inspector General recently released preliminary details from a special investigation into the reimbursements that brings into question whether patients and taxpayers are getting their money's worth.

In a letter sent to Senate Finance Committee Chair Charles Grassley (R, Iowa), who requested the investigation, Inspector General Daniel Levinson described collection of patient data as incomplete and not uniform. Doctors are not required to use a standardized form to record patients' responses and have no script to follow when asking questions about chemotherapy's side effects, Levinson wrote.

Also, visits by the IG's office to several cancer clinics determined that Medicare is offering the added payment for a service that is already part of chemotherapy patients' routine care, he stated. The $130 is actually more than the average Medicare payment for the most complex office visit billed by oncologists, yet the questionnaire is often completed by nurses over the course of a few minutes, Levinson wrote.