Many Americans — and policymakers — are sick and tired of discussing and debating the federal sequester. After 19 long months of excruciatingly stagnant debate, the myriad impacts of the across-the-board spending cuts are proving to affect some more than others, and Americans as well as elected officials are showing growing fatigue to carry the subject forward.
No, the sky did not fall on March 1, as some had predicted. But for those who are tuning out, just be glad you aren’t sick. Especially those who are battling cancer.
Among the unlucky Americans who will certainly feel the aftermath of Congress’ indecision are millions of cancer patients who depend on Medicare. Receiving a cancer diagnosis is one of the most frightening experiences one can imagine, but in the United States, this fear has been at least tempered with the knowledge that there exists an abundance of specialists and experts available to provide outstanding, life-extending care to seniors and other fighting cancer in local communities throughout the country.
The sequester changes that.
Beginning April 1, providers of community-based cancer care, where more than 80 percent of patients receive their care, will begin experiencing cuts of extreme proportions. Already on financially unstable ground because of funding shortfalls for drug therapies, the federal sequester will reduce 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 the community. The current drug reimbursement rate does not 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; as a result, many critical cancer drugs are currently reimbursed below cost. After April 1, our cancer doctors will be asked to personally help fund a portion of each Medicare patient’s treatments.
Since 2003, community cancer care has experienced a waterfall of funding reductions all while fending off an additional double digit percentage cuts to the Sustainable Growth Rate, which is the formula used in setting Medicare physician payments. The sequester and its disproportionate impact on cancer is just the latest in a series of damaging cuts that threaten patient access to cancer care through facility closures, exorbitant patient out-of-pocket copays and drug acquisition costs, or doctors’ inability to accept Medicare patients.
The question we must ask ourselves is: Who can survive a 28 percent funding cut while continuing to provide high-quality care?
The impact of further reductions of Medicare Part B reimbursements is particularly devastating because the current rate already fails to adequately pay community cancer clinics for the purchase of critical, life-sustaining cancer drugs. The current rate unfairly includes “prompt pay” discounts to drug distributors in its calculation even though these discounts are not passed on to providers — particularly community cancer clinics that provide accessible, specialized care that so many patients with limited mobility rely on.
The consequences are unambiguous. Since 2008, more than 1,200 community cancer care centers have closed, consolidated or reported financial problems. Additional cuts starting in April will force closures, restricting patient access to care and driving up Medicare costs by forcing patients to costlier institutional care settings. A recent survey by the Community Oncology Alliance shows that after April 1, 72 percent of cancer clinics will be forced to not see new Medicare patients or send all Medicare patients to a hospital for treatment. Research has shown that without access to community cancer care, patients experience higher copays, longer travel times and increased travel expenses from visits to multiple providers and locations for care and services, and delays seeking treatment even as cancer progresses.
As if cancer weren’t difficult enough, patients whose delicate health depends on routine care from specialists they trust will now bear an even greater burden.
Congress must take Medicare Part B drug reimbursements out of the sequester equation and eliminate this blind double cut that cruelly punishes cancer patients. Our nation’s lawmakers must also remove prompt pay discounts from the calculation of Medicare reimbursement rates to make the average sales price formula more closely resemble average costs.
While the bottom hasn’t dropped out yet, it will soon feel like it for many cancer patients. As a cancer survivor, I know the emotional turmoil of a devastating diagnosis and the comfort in knowing doctors and nurses in my own community were there to help me through it. The thought of doctors being forced to turn patients away or patients facing additional financial barriers that prevent access to lifesaving treatment is unconscionable.
With millions facing this devastating scenario, I hope Americans and policymakers will continue giving attention and careful consideration to the impacts of the sequester and prevent any further cuts to community cancer care. It’s a topic that, while tiresome for some, affects the lives of many. It’s critical that we don’t allow ongoing indecision in the halls of Congress to cost lives in American communities.
Nancy Davenport-Ennis is the CEO and co-founder of the National Patient Advocate Foundation.