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Archive for March, 2014

You Have Health Insurance But Can You Get Health Care?

You have health insurance. Great. Where can you go for cancer care?

Guy walking into a bad hospitalThanks to the Affordable Care Act (ACA or Obama Care), we no longer have to worry about being denied health insurance because of preexisting conditions or that we will lose our coverage because the total cost of our care has reached spending limits. So, we now have health insurance plans that we can “afford” and as long as we pay the premiums we can keep them. Wonderful.

 

But, do know where you can go to get health care?

 

While we now have health insurance where we can go for health care is a totally different story. A story surfaced again this week that points out that care at renowned cancer centers may not be covered by your insurance plan. This report, by the Associated Press, reveals that only 4 of 19 nationally recognized cancer centers are covered by all of the insurance plans in their state.

 

The 19 hospitals surveyed are all part of the National Comprehensive Cancer Network (NCCN), an alliance of 25 of the top cancer centers in the world. The NCCN creates numerous guidelines that help physicians around the world care for oncology patients but evidently they may not be good enough for your insurance company.

 

How can this be? Well, we can select a health insurance plan that we can “afford” but the hospitals that are in the plan may not the top hospitals in the country but rather the ones located next to Chico’s Bail Bonds. I say, enough of the Bad News Doctors that we are directed to by the drunken pool cleaning insurance companies.

 

The cancer care health insurance solution

 

The ACA (Obama Care) should mandate, at a minimum, that any insurance policy written in the U.S. has to cover care at any of the 68 National Cancer Institute (NCI) NCI-Designated Cancer Centers.

 

The National Cancer Institute (NCI) is part of the National Institutes of Health (NIH), which is one of 11 agencies that compose the Department of Health and Human Services (HHS). Since the HHS runs Obama Care then this solution should be easy to remedy. If Obama Care mandates other coverages (such as, pregnancy, birth control and mental health coverage) then why couldn’t a quick change of the rules by President Obama change coverage mandates for cancer patients?

 

Why is access to top cancer centers important?

 

Testicular cancer is a perfect example of why access is so important. There are more urologists and medical oncologists in the U.S. than there are cases of testis cancer each year. This means, statistically, that not every urologist or oncologist would even get to treat a new testis cancer patient every year. Think of skills or things that you only use once a year. Do you consider yourself an expert at these tasks? Well, perhaps neither are the doctors that only see one new testicular cancer patient.

 

There are doctors that are experts in testis cancer. They have dedicated a large portion of their career to advancing the treatment of this disease and see numerous patients a year. However, these doctors are not next door at the “I Try Hard Hospital” but rather at larger centers of excellence. Their volume of patients seen helps increase the quality of their outcomes. Higher volumes and better outcomes is not something new and has been shown to correlate in other disease states such as cardiac surgery.

 

These larger centers are also where the cutting edge clinical trials are being conducted and by denying coverage at these centers the insurance companies could be denying access to needed clinical trial participants. There is an Obama Care clause that mandates that insurance companies have to cover the routine costs of clinical trials but discussion of this is beyond the scope of this piece.

 

The point is that access to care to these incredible facilities and doctors should not be denied or even hindered by plans confined behind state lines. A change of the law to cover all NCI-designated cancer centers would be a start. Ideally, means of determining centers of excellence for individual disease states should be developed and coverage at these centers should also be mandated down the road.

 

If my cancer returns, I would certainly want to drive the two hours from Cincinnati, to be seen at Indiana University. If I am willing to travel there on my own dime then why shouldn’t my insurance company cover that care? After all, incredible outcomes occur under the care of these doctors.

 

Care at Top Medical Centers is More Expensive

 

Maybe my care at Indiana University would more expensive than care at the “We Try Hard” hospital down the street. I don’t even know where to start to compare the charges as most of the financial data I’ve seen in health care is derived from Medicare data that mainly applies to patients 65 and older. I have yet to find data for younger testis cancer patients, data that should easily be obtained from the insurance companies themselves if they had a national database or willingness to release and share the information.

 

Perhaps the care I received would be cheaper if there were less adverse outcomes associated with care at Indiana University. Some data suggests that outcomes are better and adverse effects are lower when retroperitoneal lymph node dissection (RPLND) surgeries are conducted by higher volume surgeons.  Indiana Is certainly a high volume center.

 

For the sake of argument, let’s assume that the cost of care at Indiana University is a bit higher than that of a local facility. So, my insurance company loses if I go to Indiana right? No, they don’t!

 

The proof dates back to September of 1974 when a dying, 23-year-old young man named John Cleland walked into Indiana University and ended up receiving the first cisplatin-based chemotherapy regimen for testis cancer. John didn’t die like the other 90-95% of the guys in his condition in the early 1970s. In fact, he was the pioneer patient for the cisplatin-based chemotherapy regimens that have saved easily over 100,000 young men’s lives. By walking through the door at Indiana University John has lived decades longer and guess what? I’m sure he paid health insurance premiums all of those years; as have his three children that he had after treatments.

 

A reasonable additional cost of care is certainly worth the benefits so we shouldn’t be denying care based on the cost. Ideally, we should base our care on physician excellence and excellent outcomes but even that system has it’s faults as doctors and hospitals might be more encouraged to deny treatments to the sickest of patients and refer them somewhere else instead. For example, after public quality data reporting for cardiac surgery was instituted in New York there appeared to be an increase in the severity of sick patients being referred to Cleveland Clinic for heart surgery. The thought is that facilities could keep their quality scores looking good if they referred their sickest patients to other states that did not have the quality reporting in place.

 

There is plenty of room to debate for the perfect system and scenarios but here is one thing that needs to be done now: The ACA (Obama Care) should mandate, at a minimum, that any insurance policy written in the U.S. has to cover care at any of the 68 National Cancer Institute (NCI) NCI-Designated Cancer Centers.

 

As cancer, or any other life-threatening disease, patients we do not have time for political debates and insurance appeals. If a federal entity, such as the NCI, designates caner centers then, at a minimum, those centers should be good enough for any insurance company to cover our care in those facilities. We can always improve from there and let’s hope there are many more John Clelands.

 

Thanks for Reading,

Mike Signature

 

 

 

 

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