Background Information
·
80% of all cancer care occurs in
community cancer centers (private practices and freestanding cancer
centers, not the hospital).
· 60%
of all new cancer diagnoses are made in Medicare beneficiaries.
· Medicare
reimbursement rules were created when most chemotherapy occurred in
the hospital.
· Outpatient
chemotherapy evolved in an effort to reduce the overall cost of cancer
care.
· Currently,
Medicare overpays for chemotherapy drugs by $570 million per year.
However, it currently underpays for the essential services (such as
infusing the medication) by $718 million annually. So Medicare
currently underpays oncologists by $148 million per year.
· Medicare
beneficiaries are required to pay 20% of the cost of their care. Many
cannot afford to do so. In those cases, they are usually treated
regardless of their ability to pay, costing community cancer clinics
an additional $200 million or more in free cancer care.
· Cancer
death rates have declined over the last five years.
· In
2002, cancer cost about $171.6 billion; $60.9 billion in direct costs,
$15.5 billion in indirect costs due to illness and $95.2 billion in
indirect costs due to premature death.
· In
the United States, men have about a 1 in 2 chance of developing
cancer. Women have about a 1 in 3 chance of developing cancer.
· This
year, 556,000 people in the United States are expected to die from
cancer, about 1,500 each day.
Provisions in the
Proposed Medicare Legislation
The Senate and House bills differ in how they cut
cancer care. However, both would cut $16 billion from
cancer care reimbursement over 10 years, a reduction of about 30%.
Although $16 billion seems like a huge cost, spread over the entire US
population, the cost of paying for this cut equals about 1.5 cents per
American per day over 10 years.
House
Bill
· Requires
a third party pharmacy chosen by the government to deliver prescribed
drugs, called mandatory vendor imposition (MVI).
· In
some cases, cancer patients would be required to pick up their
medication and bring it to their doctor’s office for administration.
· Patients
will have to return to the office at least one day after their
chemotherapy drugs are prescribed to receive the treatment; this will
require two separate pre-treatment medical evaluations.
Senate
Bill
· Decreases
chemotherapy reimbursement from 95% to 85% without increasing the
payments for chemotherapy-related services.
Implications of the
Proposed Medicare Legislation
Although these changes seem harmless, they will have a
huge impact on cancer care in America.
· Practices
cannot continue to operate at a loss for very long. Community
oncologists would have to cut costs in one of three ways:
o Make
severe cuts in patient care (by cutting highly skilled nurses and other
clinicians)
o Stop
treating Medicare patients
o Close
satellite and/or main offices.
· Any
of these strategies will severely limit access to life-saving and
life-prolonging treatment for our sickest Medicare patients. If oncology
practices cannot give chemotherapy, cancer patients must:
o Receive
chemotherapy in the hospital
o Receive
chemotherapy and cancer care in university medical centers
o Forgo
cancer treatment.
· Receiving
chemotherapy in the hospital may harm cancer patients because:
o Being
admitted to the hospital for chemotherapy adds several hours onto an
already exhausting day for a weak, tired, sick patient. It may also
increase travel time significantly.
o
Hospitals have more serious bacteria than
homes, in greater numbers. Cancer patients have severely weakened immune
systems from chemotherapy and are much more susceptible to infection.
Serious infections lead to long, expensive hospital admissions.
o
Hospital nursing teams are notoriously
understaffed and overburdened, each caring for more patients than
outpatient chemotherapy nurses. Chemotherapy is extremely toxic;
patients need close monitoring during their 2-8 hour infusions. Some
patients have life-threatening reactions to chemo requiring
resuscitation by a doctor who may not be available in the hospital.
o
Hospitals are already overflowing with more
patients than they can handle. They cannot care for five times as many
patients as they currently treat. Those additional patients they can
treat will have to wait for treatment, leading to less effective cancer
treatment.
o
Hospitals already lose money on inpatient
chemotherapy. Treating more patients at a loss will ultimately force
them to either stop providing chemotherapy or close.
· The
MVI provision in the House bill is also harmful for cancer patients. The
system would:
o
Cause treatment delays
o Require
patients to have multiple visits and multiple co-pays and in some cases
pick up their medication and bring it to their doctor’s office.
o Possibly
lead to substandard chemotherapy due to improper storage, mixing, or
transport.
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