Mar 13, 2019

Hospitals aren't getting paid for CAR-T cancer treatments

Dr. Christian Hinrichs, an investigator at the National Cancer Institute. Photo: Saul Loeb/AFP/Getty Images

It's hard to set the price for a new kind of procedure until you’ve done it a couple of times, but it's hard to do it very often if you can't get paid for it. And that dynamic is causing headaches for hospitals as they wade into the complexities of CAR-T cancer treatments.

Why it matters: This isn't necessarily the standard kind of payment dispute we're used to seeing between hospitals and insurers.

"It's dealing with the uncertainty … of all the contracting, exactly how much am I going to get paid, and am I going to have to provide a discount [to the insurance company] for some parts and not others, and how much is it going to be?" Boston University professor Rena Conti told STAT.

  • CAR-T is expensive, but Medicare is going to cover it, and independent analyses suggest it's worth its high price tag.
  • As they wait to follow Medicare's lead on pricing, both insurers and hospitals are more comfortable for now working out individualized, one-off payment agreements.

The bottom line: A new and complex and payment system on top of a new and complex treatment makes it hard to figure out a price, and payment can take a long time to come through, even when everyone's cooperating.

  • "It doesn't mean there's a problem, necessarily. These are very complex claims. But we have not been paid," Virginia Commonwealth University's Penny Trentham told STAT.
  • But without those payments, it's hard to keep doing CAR-T treatments — and to learn the right price.

Go deeper: Cancer hospitals lobby for pricier Medicare CAR-T payments

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Trump rules out quarantine in New York, New Jersey, Connecticut after pushback

President Trump on the White House grounds on Saturdya. Photo: Sarah Silbiger/Getty Images

President Trump tweeted Saturday night that he's decided not try and enforce a short-term quarantine on New York, New Jersey and parts of Connecticut, but a "strong" travel advisory will be issued for those states.

Why it matters: The president said hours earlier he was considering the move to combat the rise in novel coronavirus cases. But he received pushback, most notably from New York Gov. Andrew Cuomo (D), who told CNN it would cause "chaos." "This would be a federal declaration of war on states," Cuomo added.

Trump weighs quarantine of New York, New Jersey, Connecticut

Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios

President Trump said Saturday he's considering a short-term quarantine of New York, New Jersey and parts of Connecticut, which have already taken steps to help residents isolate. Gov. Andrew Cuomo reacted to Trump's comments by telling CNN, "This would be a federal declaration of war on states" and that it would cause "chaos."

The big picture: With more than 121,000 people infected, the U.S. has the most COVID-19 cases in the world, exceeding China and Italy, per data from Johns Hopkins. A second wave of American cities, including Boston, Detroit, New Orleans and Philadelphia, are reporting influxes of cases.

Go deeperArrowUpdated 28 mins ago - Health

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 7:30 p.m. ET: 660,706 — Total deaths: 30,652 — Total recoveries: 139,304.
  2. U.S.: Leads the world in cases. Total confirmed cases as of 7:30 p.m. ET: 121,478 — Total deaths: 2,026 — Total recoveries: 1,072.
  3. Federal government latest: President Trump is considering a quarantine on New York, parts of New Jersey and Connecticut.
  4. State updates: Alaska is latest state to issue a stay-at-home order — New York is trying to nearly triple its hospital capacity in less than a month and has moved its presidential primary to June 23. Some Midwestern swing voters that supported Trump's handling of the virus less than two weeks ago are now balking at his call for the U.S. to be "opened up" by Easter.
  5. World updates: In Spain, over 1,400 people were confirmed dead between Thursday to Saturday.
  6. 🚀 Space updates: OneWeb filed for bankruptcy amid the novel coronavirus pandemic.
  7. Hollywood: Tom Hanks and Rita Wilson have returned to U.S. after being treated for coronavirus.
  8. What should I do? Answers about the virus from Axios expertsWhat to know about social distancingQ&A: Minimizing your coronavirus risk
  9. Other resources: CDC on how to avoid the virus, what to do if you get it.

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