Doctors fear lower Medicare drug payments will hurt cancer clinics
Scandal prompted bill's writers to cut reimbursements
Dan Freedman, Hearst Newspapers Thursday, November 27, 2003
Washington -- Doctors who treat cancer patients say the new Medicare program approved by Congress last week will hurt their ability to operate small oncology clinics and administer chemotherapy.
"This bill is so devastating," said Dr. William Schmidt, an oncologist in Charleston, S.C. "I feel like my legs are being cut off -- that I can't practice medicine the way a doctor should."
At issue are the complicated formulas that the Medicare program uses to reimburse doctors for chemotherapy drug purchases and the expense of operating small cancer clinics.
The new Medicare program's headline feature is prescription drug coverage for the 38-year-old system's 40 million elderly and disabled beneficiaries.
But it also cuts at least $4.2 billion over 10 years from drug treatments primarily for Medicare patients with cancer, according to a Congressional Budget Office analysis.
Cancer specialists such as Schmidt say the cuts will lower Medicare reimbursements and lead physicians to re-evaluate whether they can afford to continue treating Medicare patients.
The cuts also may force layoffs of clinic nurses and other personnel, and the closing of smaller satellite clinics that serve patients away from urban areas, the specialists say.
"This is the largest cut to cancer care since Medicare started" in 1965, said Deborah Kamin, policy director for the American Society of Clinical Oncology. "We don't want to panic people and scare patients, but this is a cut to cancer care of historic proportions."
Rep. Michael Rogers, R-Mich., himself a survivor of bladder cancer, said he shared the same concerns, but he added that it was too early to predict the exact impact.
"I'm a little nervous that when all is said and done, we may have taken a bigger bite (out of cancer care) than intended," Rogers said.
Congressional targeting of cancer clinics goes back about two years to investigations on Capitol Hill that revealed doctors obtained cancer-fighting drugs at bargain-basement prices but then received Medicare reimbursements for five times the amount they paid.
For instance, the House Energy and Commerce Committee in 2001 found that doctors paid $1.25 for 50 milligrams of Leucovorin, used in combination with chemotherapy to treat various forms of cancer. But Medicare reimburses the physicians $35.47 for that amount of Leucovorin.
Cancer doctors say the excess money goes to offset the cost of staffing and maintaining their clinics.
Medicare reimbursements for clinic expenses are insufficient, so doctors have come to rely on generous payments for drugs to keep their practices afloat, they say.
The Medicare reimbursement system for cancer care was developed in the 1960s and 1970s, when most cancer treatment took place in hospitals.
Medicare reimbursed doctors at a high rate for cancer-fighting drugs because the federal system factored in the time that high-salaried doctors took to administer the drugs in hospitals.
Fast forward to the 1990s: Chemotherapy and other forms of cancer treatment increasingly are administered not in hospitals, but in small oncology clinics operated by the doctors themselves.
But Medicare, under the old formula, reimbursed clinic and office expenses at a much lower rate. At the same time, doctors have incurred new practice expenses because they now must pay the cost of operating and staffing clinics.
The Medicare legislation attempts to address the imbalance by taking away from the cancer doctors' drug reimbursement and adding to their office-expense reimbursement.
According to the CBO, the legislation's $4.2 billion cut primarily affects Medicare reimbursements for drugs. Doctors can expect an increase in office expenses amounting to about $3 billion over 10 years, the CBO concluded.
Whether it all balances out properly over the next decade or leads to clinic closures is the subject of intense debate.
Rogers said he and others in Congress were forming a task force to monitor cancer clinics and call lawmakers to action if low reimbursement rates led clinics to close.
"I want to make sure that if we've made a mistake in our calculations, cancer patients don't pay the price," Rogers said. |
