Cutting cancer patients’ care is not the right fix

Cancer care in the U.S. has entered a state of crisis. In communities nationwide, an alarming number of patient-preferred local clinics – which provide state-of-the-art cancer care to more than 80 percent of America’s cancer patients – are shutting down. There have been 199 reported closures over the last three years due to inadequate reimbursement, according to the Community Oncology Alliance’s latest estimate, and hundreds more are struggling to stay open.

{mosads}When community cancer clinics close and patients move to hospitals for their care, many of which are farther away, this impacts both the patient and taxpayers. For example, a recent Milliman study found total Medicare spending on chemotherapy patients to be significantly lower in the physician’s office, amounting to an extra $623 million saved per year. And when patients must travel farther for treatment, this leads to added transportation costs and more time spent away from home and loved ones.

Although community cancer centers continue to provide efficient care delivery, the latest technologies and best practices, they are grappling with a flawed reimbursement method for drugs and services that is threatening their survival. This average sales price (ASP) based payment mechanism for life-saving cancer drugs has led to substantial reductions in Medicare payments, and reimbursement that often does not even cover clinics’ overhead, staff time and services required for administering complex, time-intensive chemotherapy regimens.

Insufficient reimbursement for cancer drugs under ASP is also contributing to the dangerous drug shortage impacting cancer care. Without the financial incentive to produce widely relied upon generic injectable cancer drugs, manufacturers are discontinuing production and sources for these medications are consolidating – which means that when one facility has a manufacturing glitch, the effects are far-reaching. As leading oncologists recently testified before lawmakers, these shortages are resulting in rationing of drugs and severe price gouging. “Right now it feels like practicing medicine in a third world country,” one oncologist said of her daily medical practice.

This undermining of cancer care during a time where we should be stepping up our investment in saving and prolonging lives has unintentionally resulted from right-minded but untested policy changes that have shifted the way cancer care is delivered. But instead of now working to thoughtfully reform and bolster the nation’s cancer care foundation, some policy proposals have recently emerged that could cripple cancer care delivery. This includes lowering Medicare Part B payments for cancer-fighting drugs under ASP – which would be too much for community clinics to bear, since they rely on fair payments on these medications to account for staff time with patients and other vital care services.

In contrast, almost 50 bipartisan Congressional leaders have co-sponsored progressive, forward-looking legislation, HR 905 (Whitfield/Green) and S 733 (Stabenow/Roberts), to correct the current ASP payment calculation and strengthen the viability of community practices by ensuring more appropriate payment under Medicare Part B. This is a substantial step in the right direction, and I urge more lawmakers to join this bipartisan effort to improve cancer patients’ access to care in the community.

Let’s not wait until cancer care, like physician payment, is at the edge of the cliff. We should look ahead, modify and improve the current reimbursement structure and create appropriate incentives for manufacturers to continue bringing life-saving cancer drugs to market. And in doing so, we should not adversely impact oncologists and the community based clinics that are dramatically improving the survival rates of today’s patients battling cancer.

We have made tremendous progress in the war declared on cancer Congress declared 40 years ago – and in the haste of another physician payment quick fix on Capitol Hill, let’s not lose that all-important war now by taking our eye off patients’ access to local clinics, state-of-the-art-care and therapies that are saving their lives.

Ted Okon is the Executive Director for the Community Oncology Alliance