Financial Implications of the American Health Care System
Mort's last entry speaks of why RIT has been so underutilized. I'm going to expound on this with the hope that it will help each and every one you to make a more informed decision.
Few of us understand the way Medicare and insurance pay for our treatments. I certainly didn't, and it is only recently that I have come to understand this - with the help of doctors and reimbursement specialists.
Medicare determines the amount physicians should be paid based on the value of their services. Most private insurers base their reimbursements on Medicare's fee schedule.
Up until the late 1980's, most chemotherapy required hospital stays. As new drugs were developed to offset side effects, chemo could be administered in doctor's offices. This was actually better for patients who no longer had to stay in the hospital for treatment, and Medicare designed a program to allow oncologists to administer chemotherapy drugs in their offices. While this reduced the cost of cancer care, it also basically turned oncologists into retail pharmacists because it allowed them to profit from the drugs they prescribe. They are not required to disclose this fact to patients.
In the case of RIT, oncologists must refer patients to nuclear medicine physicians or radiation oncologists who administer the treatment. Thus oncologists lose the income that is generated by drugs they can prescribe - namely, chemotherapy and Rituxan.
Lest oncologists come under fire for this, we must remember that they work within a system which they did not create and that reimbursements for drugs help to cover a host of services that are not billable. I've talked with many doctors who as frustrated with the system as I am. It has not kept pace with the development of new drugs such as RIT which requires a team effort by both an oncologist and a nuclear medicine physician or radiation oncologist.
This places the burden squarely on the shoulders of the people who turn to the medical community when they need help most - patients. The system forces us to understand its financial implications before deciding on a treatment plan. At the same time, we must establish a trusting relationship with our doctors. Perhaps this lousy system merits a conversation with your oncologist - or as Mort has suggested - a consultation with a nuclear medicine physician or radiation oncologist. You do not need your oncologist's permission to do so.
Betsy