Abstract
Materials/Methods: The study facilities include a small semi-urban, an inner-city, an urban, a rural, and a control hospital located in a semi-urban area. Using the UPMC EPIC billing system, new patients diagnosed with cancer who had consultations (CPT-4 codes: 99201-5, 99241-5, 99251-5) during 2003-2007 were identified. Results: The overall proportion of newly diagnosed cancer patients who had consultations and were insured by Medicare HMOs increased from 20.9% in 2003 to 26.5% in 2007. The estimated monthly cost of a qualifying clinical trial for a patient was $112.80 for trial #05-025, $326.60 for trial #03-091, $2,152.20 for trial #06-112, and $3082.8 for trial #05-044. In 2007, 103 subjects were screened for clinical trials in the UPMC cancer centers and opted out of enrolling on a Medicare qualifying clinical trial due to increased financial burden. Conclusions: Since the passing of the Medicare Modernization Act and the establishment of Medicare Advantage in 2003, the number of Medicare beneficiaries enrolled in managed care has increased. Our results are consistent with the national trend that there is an increasing number of aging cancer patients enrolled in Medicare HMOs. Our findings suggest that Medicare HMO reimbursement policy hinders cancer clinical trial participation in the ROCOG facilities.
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