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Cancer Care Rests in the Community -- and in Logical Medicare Payment Policies | Commentary

Health care providers are never comfortable putting their work in purely economic terms, but the financial realities of the current system simply cannot be ignored. Hospital-based cancer care costs more, yet a community-based environment for the same care has become unsustainable. Cancer clinics are small businesses forced by policy to operate at a loss, which is hard to imagine accepting for any business, whether itís a hardware store or a health care provider.

The National Cancer Institute estimated that there were about 13.7 million Americans living with cancer in the U.S. last year ó more than half of those over the age of 65. With about half of all cancer spending associated with Medicare beneficiaries, and as millions of baby boomers continue to reach the age of 65, the time is now for Congress to act to ensure the future of community-based care and stop the site-of-service shift into hospital outpatient departments.

Legislation by several leaders in Congress has provided a starting point. HR 800, sponsored by Rep. Edward Whitfield, R-Ky., to make chemotherapy reimbursement more accurate, and HR 1416, sponsored by Rep. Renee Ellmers, R-N.C., to mitigate the sequesterís effects on cancer care, would address several key issues. Another important step is HR 2869, co-sponsored by Mike Rogers, R-Mich., and Doris Matsui, D-Calif., to level the playing field between community cancer centers and hospital outpatient departments.

Equalizing payments for the same service regardless of setting will help stem the tide of hospitals acquiring community oncologists. Enactment of these bills will allow patients to gain access to cancer care at sites they prefer and keep the costs of fighting cancer affordable for seniors, Medicare and taxpayers. These bills are crucial for patients, for Medicare, for the future of our nationís world-class cancer care ó and I hope policymakers will embrace them.

Barry Brooks, M.D., is chairman of the Pharmacy & Therapeutics Committee for The U.S. Oncology Network.

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