title: The Medicare Modernization Act and reimbursement for outpatient chemotherapy: do patients perceive changes in access to care?
abstract: BACKGROUND
  The primary objectives were to measure and compare time to initiation of chemotherapy for patients undergoing treatment either before or after the enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), and to measure and compare the location of care for patients undergoing chemotherapy either before or after the enactment of the MMA.
  
  
  METHODS
  A Web-based survey was conducted of a convenience sample of patients with cancer.
  
  
  RESULTS
  A total of 1421 respondents completed the survey, 684 in the pre-MMA group and 737 in the post-MMA group. Respondents aged >or=65 years in both the pre-MMA and post-MMA groups had a median waiting time to chemotherapy of 3.0 weeks (P = .74). Most respondents aged >or=65 years received chemotherapy in outpatient hospital infusion centers or centers affiliated with private practices (73% in the pre-MMA group vs 62% in the post-MMA group; P = .02). However, in multivariate analysis there was no statistically significant difference in treatment location between the pre-MMA and post-MMA cohorts.
  
  
  CONCLUSIONS
  Overall, the findings do not support generalizations from anecdotal reports that patients have been affected by the change in reimbursement to oncologists for chemotherapy as a result of the MMA. The analysis may be confounded by payments to physicians in the concurrent Centers for Medicare and Medicaid Services cancer demonstration project because these payments may have delayed changes in care. Moreover, research is needed to examine the effects of the legislation on vulnerable populations.
authors.affiliation: Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
authors.forename: Joeëlle Y
authors.initials: JY
authors.lastname: Friedman
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.forename: Jatinder K
authors.initials: JK
authors.lastname: Dhillon
authors.forename: Charles H
authors.initials: CH
authors.lastname: Weaver
authors.forename: Sugata
authors.initials: S
authors.lastname: Biswas
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Schulman
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000458:organization & administration*; D017060:Patient Satisfaction; D012051:Reimbursement Mechanisms; D014481:United States
chemical_list: D000970:Antineoplastic Agents