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The past several weeks in Washington have been chaotic and laced with uncertainties for all Americans, but particularly for federal workers whose livelihoods depend on a functioning government. Many of them certainly awoke each morning asking themselves if they would report to work that day, when they might expect their next paycheck, and how they might afford their childcare, health care or next mortgage payment.
Chaos and uncertainty turn even the most stable lives upside down. So imagine the impact that type of disarray and uncertainty is causing thousands of American cancer patients who have been forced to wonder when and where their next treatment might be available due to Medicare policies for cancer treatment.
We don’t have to look very far to see firsthand the consequences bad health care policy wreaks in the lives of patients. As the chief medical officer of US Oncology — representing more than 1,000 oncologists and the patients they serve — I can tell you that current instability in the Medicare payment system has forced closures of community cancer practices, requiring patients to travel longer distances for more inconvenient and more expensive care and negatively affecting continuity of care.
Illogically, current policies actually drive up the cost of care for Medicare, taxpayers and seniors by forcing many patients into the hospital setting away from convenient and cost-effective community cancer clinics, while simultaneously increasing the burdens on patients.
Just eight years ago, 87 percent of cancer care was provided in community cancer clinics. By 2011, that had dropped to 67 percent and the shift to hospital-based cancer care accelerated in 2012 and 2013 with a 20 percent increase in the rate of oncology clinic closings and hospital acquisitions. This has resulted in seniors with cancer losing access to cancer care close to home — particularly in rural areas — and both seniors and Medicare paying more for cancer care.
Fueling this unfortunate shift are Medicare policies that have imposed cut after cut on community oncology clinics while creating an environment that gives financial incentives for care delivered by hospitals. For example, under the 2013 Medicare payment rules, hospitals are paid 51 percent more than community cancer clinics for a representative mix of chemotherapy administration services. This differential would increase to 99 percent if the Centers for Medicare and Medicaid Services’ proposals for 2014 are implemented, meaning that Medicare will pay twice as much for chemotherapy administration services in the hospital versus community clinic setting.
As another example, under the 2013 Medicare payment rules, Outpatient Prospective Payment System and Medicare Physician Fee Schedule payments are about the same across a representative mix of radiation therapy services. But the proposed 2014 rules would create a significant site-of-service differential with payments to hospitals about 55 percent higher than community oncology practices and freestanding radiation therapy centers.
Our doctors’ first and foremost want is what’s best for patients. But as taxpaying Americans, we also want Medicare dollars to be spent as efficiently as possible. Interestingly, recent studies conclude that the cost of treating cancer patients is significantly lower for both Medicare patients and the Medicare program when performed in community-based clinics compared with the same treatment in the hospital setting. According to a 2013 Moran Co. report, hospital outpatient-based care results in the utilization of more and more expensive chemotherapy drugs, and a 25 percent to 47 percent higher chemotherapy bill for Medicare and seniors.