U.S. Congress - Medical malpractice

October 13, 2008
President George W. Bush
The White House
1600 Pennsylvania Avenue NW
Washington, DC 20500

Dear Mr. President,

I am very concerned about the economic crisis.

It seems criminal for a Medicare service provider to eliminate a cancer treatment option that would same the country tens of millions of dollars and benefit cancer patients at the same time. Medicare providers Palmetto in California and Trailblazer (TX, OK, CO and NM) are increasing Medicare cost and providing lower quality medical care. Both have eliminated stereotactic body radiation therapy (SBRT)/CyberKnife coverage for prostate cancer treatment. The previous Medicare providers covered SBRT for prostate cancer. The alternative external beam treatment, IMRI, will double the cost to Medicare and increase the cost for patient’s transportation and lodging (if required) by 800%. Trailblazer stopped paying for prostate cancer treatment with SBRT June 13, 2008. Effective Dec. 15, 2008 Palmetto will stop treatment of prostate cancer and cancer of the pancreas.

Patients should be entitled to have a say in selecting the best treatment for their best quality of life and most important their life. This should be a fundamental right.

Please consider the actions of these Medicare providers and take corrective action to save millions of dollars and improve medical treatment for cancer patients. In my opinion both of these providers should have their contracts suspended for cause.

My e-mail below to Daniel R. Levinson, Inspector General has the details for the specifics in California.

Please feel free to have a staff member contact me at any time.

Best Regards,

Fred
Saratoga CA 95070
408

Date: Sun, 12 Oct 2008 20:43:44 -0700
To: HHSTips@oig.hhs.gov
From: Fred Kinder <fred@usea.com>
Subject: Medicare Abuse by Palmetto Government Benefits Administrators (GBA) /California
Cc: Senator Barbara Boxer, Senator Dianne Feinstein, Senator Hillary Rodham Clinton, KPIX Craig Franklin
Bcc: Accuray Susan Thompson, Accuracy Catherine_Bonetti, Accuray Debra Mills, Accuray Jim English, Doctor Adler, Doctor Clinton_Medbery, Doctor LaNasa_Peter, Dr. Alan Katz, Dr. D. Fuller, Dr. King Stanford, Dr. Spunberg

Office of the Inspector General
HHS TIPS Hotline
P.O. Box 23489
Washington, DC 20026
Mr. Daniel R. Levinson

Dear Mr. Levinson, Inspector General

California Medicare provider Palmetto Government Benefits Administrators (GBA) just re-released their policy guide lines for cancer treatment by stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) in draft form. Palmetto is removing a cancer treatment by SRS/SBRT/CyberKnife for the Prostate and Pancreas. This will result in higher cost to Medicare, higher cancer failure rates adding to patient suffering and additional treatment (adding cost), higher incidence of side effects reducing the quality of life for patients. This treatment was covered by the previous Medicare administrator. Why would, SRS/SBRT, the best External Beam (EB) radiation treatment for prostate cancer be removed? The new policy now covers an External Beam radiation option (IMRT) that cost a 100% more than SRS/SBRT , has increased side effects and a lower cancer cure rate. Why? Also consider the Palmetto EB option (IMRT) requires 40 days of treatment. The SRS/SBRT by CyberKnife requires 5 days of treatment. The cost of patient travel and inconvenience is 800% higher as the result of the irresponsible actions of Palmetto.

Palmetto was provided medical evidence by experts in the field (see attachment) for reconsideration before they re-released their policy changes. Their final comment period runs from Oct 30 thru Dec 15, 2008.

The Center for Medicare and Medicaid (CMS) mission statement is as follows:

CMS’ mission is to ensure health care security for its beneficiaries. A major component in achieving this mission is the successful administration of Original Medicare, or Fee-for-Service (FFS) Medicare. Medicare Contracting Reform (or section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) is a major component in achieving this mission. Section 911 mandates that the Secretary for Health & Human Services replace the current contracting authority to administer the Medicare Part A and Part B FFS programs, contained under Sections 1816 and 1842 of the Social Security Act, with the new Medicare
Administrative Contractor authority. Through the implementation of Medicare Contracting Reform, CMS will establish a premier health plan that allows for comprehensive, quality care and world-class beneficiary and provider service.

In summary the Palmetto changes are not in compliance with CMS Medicare Reform. World-class treatment for early state prostate cancer is SRS/SBRT. Their changes will also cost Medicare additional millions of dollars and reduce the patient’s quality of life. Patients should be entitled to have a say in selecting the best treatment for their best quality of life and most important their life. This should be a fundamental right. In my opinion Palmetto is acting as a Doctor (do they have a license to practice medicine?) for Medicare patients. If they are, then their actions are in violation of the Hippocratic Oath. Is Palmetto acting as a Doctor?

As a result of my personal fight with Blue Shield of California for prostate cancer treatment by the CyberKnife I have become a prostate cancer advocate for research, education, screening and treatment. The story with Blue Shield can be viewed at the following CBS link http://cbs5.com/investigates/CyberKnife.blue.shield.2.716740.html . FYI, Blue Shield of California added the CyberKnife as a treatment option for prostate cancer July of 2008,

Please enforce the CMS policies on Palmetto so they can not remove SRS/SBRT as a cancer treatment option for prostate and pancreas cancer.

Contact me if you have any questions.

Best Regards,

Fred
Saratoga, CA 95070
Cell 408