What Cancer Patients Want versus What Medicare Covers: Study Findings

According to a recent study, when asked what Medicare should cover for cancer patients in their last months of life, many patients and their caregivers chose benefits not offered by Medicare, including home-based long term care (LTC) and concurrent palliative care [J Clin Oncol. 2014; DOI:10.1200/JCO.2013.54.2605].

Given an array of options, a limited budget, and a chance to discuss the choices, patients and caregivers were not very likely to devote all coverage to curative cancer treatment, according to lead author, Donald H. Taylor Jr., Sanford School of Public Policy, Duke University, Durham, North Carolina, who based the study on interviews.

Medicare covers what it defines as “reasonable and necessary care” and its standards have come to guide what private insurers are willing to pay for as well, according to the researchers. As federal cost cutting continues to target Medicare spending, the risk that patient choices will be narrowed could increase.

To gauge what cancer patients most want from Medicare coverage, the researchers interviewed 400 participants who were either Medicare beneficiaries ≥65 years of age undergoing treatment for cancer, had recently been treated for cancer, or were caregivers helping to care for a cancer patient on Medicare. Of the 194 caregivers, most were spouses of cancer patients.

Half of the patients reported spending more than $2000 out-of-pocket on medical care over the past year.

The participants met in small groups for a 2.5-hour session that distributed educational materials about Medicare benefit categories, individually chose benefit categories, and discussed as a group what benefits should be covered.

Each person was given a circular game board and 50 stickers to allocate between 15 benefit categories, some of which are not covered by Medicare. The number of stickers given to each benefit category indicated the level of care the patient or caregiver wanted for that benefit.

Some of the Medicare-covered benefit options categories were cancer therapy and primary care. Some of the benefit options not covered by Medicare were cash payments, home-based LTC, and concurrent palliative care that is integrated into cancer treatment.

The researchers estimated that Medicare funds approximately $35,000 for each cancer patient during the last 6 months of life. Divided into 50 units, that meant that 1 sticker on the board represented $700 of coverage.

Almost all participants allocated coverage to cancer care itself, usually an intermediate or high level of care, and most also chose primary care and prescription drug coverage, which are covered by Medicare.

More than 80% of participants also chose palliative care, home care, and nursing home care. Only 12% of participants chose the maximum amount of cancer care.

Approximately half of the group also chose some level of unrestricted cash, home-based LTC services, or concurrent palliative care, which is beyond the current hospice benefits covered by Medicare. People who chose these categories allocated up to 30% of their hypothetical budget to them, according to the study’s findings.

Currently, Medicare covers curative cancer treatment and hospice care, but not concurrently. Many participants in this study were interested in concurrent palliative care, which may indicate that the system needs an overhaul.—Kerri Fitzgerald