Just when we all thought Congress was gridlocked beyond hope, it successfully pushed through a legislative change that would improve the daily lives of millions of Americans. It didn’t improve funding for poor children whose programs had been cut by the federal sequester, and it didn’t work to make changes that would safeguard public health or safety initiatives.
Working together and reaching across the aisle, the members quickly and decisively made changes that ensured their flights to and from Washington, D.C., would not be delayed as a result of cuts from the sequester.
If only cancer patients could be so fortunate.
Coast to coast, cancer patients who rely on Medicare to help fund their lifesaving treatments are facing hardships far more inconvenient than a delayed airline flight. The effects of the sequester have made it financially impossible for many outpatient cancer centers to treat Medicare patients and keep their doors open. Doctors and nurses — who are committed to saving lives — are now being forced to do the unthinkable and turn away sick and elderly patients.
We knew this day was coming, but that doesn’t make the reality of what’s happening any easier to bear.
Effective April 1, the federal sequester reduced reimbursement for Medicare Part B cancer therapies from the current payment rate of the average sales price plus 6 percent to just ASP plus 4.3 percent, resulting in severe financial losses for practices that treat cancer patients in communities. Even before this change, the drug reimbursement rate failed to adequately pay for the acquisition and related costs (such as storage, inventory, waste disposal, pharmacy and admixture facilities and staff) of life-sustaining cancer drugs.
The result is that many critical cancer drugs are reimbursed below cost. The additional sequester-related cuts mean that unless cancer doctors personally fund a portion of each Medicare patient’s treatments, patients must look elsewhere for care.
The stories flooding in from around the nation are startling and heartbreaking — not just the patients who are having their care continuum interrupted or delayed as they seek access to lifesaving treatments in hospital savings, but also from oncologists and caregivers in the community-based setting who have no choice but to redirect their patients elsewhere.
One of the painful ironies of this devastating situation is that not only is Congress failing the elderly Americans who rely on Medicare, it is failing at the task of actually saving any real money by implementing these cuts. Facility closures and consolidations force patients out of the cost-effective, community-based settings they prefer and into costlier settings for their care.
Cuts are shown to directly impact patients through higher copayments, longer travel times and increased travel expenses, visits to multiple providers and locations for care and services, and delays seeking treatment even as cancer progresses. All of these factors result in less streamlined care, increased chances for complications and often duplicative tests or procedures. It’s bad care and it’s bad business for Medicare.
Recent events have shown us that it is indeed possible for Congress to work together when the inconvenience of budget cuts hits too close to home. Considering that 1 in 3 Americans will be affected by cancer at some point in their lifetimes, I hope Congress will give the same consideration and decisive action to cancer care. It could soon be themselves, their friends or their loved ones who are turned away by doctors amid a deadly disease.
Nancy Davenport-Ennis is the CEO of National Patient Advocate Foundation, a national nonprofit organization providing the patient voice in improving access to, and reimbursement for, high-quality health care through regulatory and legislative reform at the state and federal levels.