Dr. Jeffery C. Ward, a cancer specialist, has not yet faced the painful task many of his colleagues have this year: closing the door to patients because of federal budget cuts. But that’s only because Ward already made the hard choice of switching from running a private practice to serving on staff at a large hospital.
“We have escaped having to turn patients away,” said Ward, who now works for Swedish Medical Center in Seattle.
Recent news reports have blamed the sequester’s automatic spending cuts as the reason cancer patients have been forced to switch to new cancer centers in the middle of their treatments. But the sequester’s 2 percent slice in Medicare payments has really only exacerbated the recent rapid consolidation of cancer centers, a trend triggered by budget decisions made a decade ago.
With the Medicare Modernization Act of 2003 (PL 108-173), Congress changed a payment system for drugs administered in doctors’ offices that had been seen as ripe for abuse in the form of excess payments.
This made it distinctly less profitable to run smaller practices. Of 1,254 practices counted in a survey by the nonprofit Community Oncology Alliance, more than 500 had been consolidated through mergers or acquisitions, often with hospitals, between 2008 and 2012. Another 241 closed, and another 47 reported turning away patients, according to the survey results.
The sequester began taking effect on March 1 and is adding pressure to a network of smaller cancer practices already under financial pressure. As a result, more people will have to switch centers. That can create burdens such as longer commutes or potentially more cumbersome check-in procedures for patients already fatigued from fighting cancer, said Ward, who is the chairman of the American Society of Clinical Oncology’s clinical practice committee.
“It can have a dramatic and severe impact on patients for whom just getting out of bed can be quite a feat,” he said.
There are only anecdotal reports that patients have been turned away from cancer clinics this year, and there doesn’t yet appear to be a solid estimate of how many people could be affected this way by the sequester. North Shore Hematology Oncology Associates in New York says as many as 3,700 of the 25,000 patients the site sees in a year may have to switch to new treatment centers.
Democratic Sen. Barbara Boxer of California said on the Senate floor last month that she had heard about people who were turned away from cancer clinics.
“I understand we are truly suffering in this country,” said Boxer, who has called for a repeal of the sequester.