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Seniors beware: Proposed Medicare changes can limit access to life-saving health care PDF Print
Friday, May 30, 2014 8:00 PM

BY DR. TERRY O’TOOLE

Chair, Insurance Subcommittee

Ohio Gastroenterology Society

Gastroenterologists are physicians who specialize in the diagnosis and treatment of diseases affecting the digestive system. We treat patients with life-threatening illnesses, including colorectal cancer, which is the third leading cause of cancer and cancer related deaths in the United States.

The risk of developing colorectal cancer significantly increases in patients 50 years and older. This means that Medicare eligible patients are much more susceptible to this cancer. Early detection through colonoscopy screening is an effective tool in decreasing the death rates from colorectal cancer. If colorectal cancer is detected, curative surgical resection can improve survival rates. More advanced colorectal cancers will require the use of chemotherapy and/or radiation therapy.

Even though early detection and better treatments have reduced the death rates from colorectal cancer, this progress is in jeopardy because federal lawmakers have plans to cut Medicare reimbursement rates for a wide range of therapies, including cancer treatments. If enacted, these cuts could leave thousands of Ohio patients without sufficient access to the life-saving treatments they need. Cuts already in place have meant that many community cancer clinics are not recouping their costs to purchase and administer chemotherapy drugs. Additional cuts will only make the situation worse.

Since 2003, doctors who administer these sophisticated treatments purchased the medications and were reimbursed according to the average sale price (ASP) of each drug plus another six percent. Because these medications are difficult to ship, store and require office staff to administer, the six percent add-on was intended to cover those costs. Generally, it did – but just barely.

 

In 2013, under budget cuts known as “sequestration,” this reimbursement rate was cut further. An across the board 2 percent cut was made to many Medicare reimbursements, which led to a further decrease in reimbursement for physicians who purchase and administer these life-saving chemotherapies to ASP + four percent. For many community cancer clinics that were barely able to afford chemotherapy drugs prior to these newly implemented changes, these newest changes have been devastating. Over the last six years roughly 290 oncology clinics have been closed down, according to the Community Oncology Alliance. Another 400 clinics are struggling financially. These lower Medicare reimbursement rates could drive even more clinics out of business. The facilities that do remain open will be forced to turn away some of the most vulnerable Medicare patients. If seeing Medicare patients becomes a financial liability under these new changes, many clinics could respond by accepting fewer Medicare patients.

In addition to these existing cuts mentioned above, even further cuts to Medicare Part B, which pays for intravenous and injectable drugs, are under consideration. Senator Sherrod Brown and Representative Pat Tiberi strongly oppose these misguided proposals. We should support their efforts or our community clinics may not survive – and the patients will ultimately pay the price. Ohio’s rural residents will be hardest hit. Already, these patients face serious obstacles to treating their illnesses. Additional Part B reductions will only exacerbate rural access issues, putting the few community-based clinics available to rural Ohioans in jeopardy of financial collapse.

Even though Part B cuts are intended to reduce healthcare costs, some fear they would likely have the opposite effect. According to a report from the actuarial firm Milliman, chemotherapy patients treated in an outpatient hospital based setting have significantly higher costs than those treated in a doctor’s office or a community clinic. Indeed, the Moran Company recently confirmed hospital chemotherapy can be up to 47 percent more expensive. If more clinics shut down, patients will be forced to turn to hospitals for their physician-administered therapies, driving healthcare costs up in the process.

Cancer patients are not the only ones affected. Seniors with conditions like inflammatory bowel disease, MS, and rheumatoid arthritis — many of whom require regular infusions of physician-administered drugs — could see their treatment options dwindle. As Ohio representatives in Washington consider further proposals to cut Medicare Part B they should consider their vulnerable seniors and disabled constituents. Our healthcare centers are already struggling to pay the bills, and it’s no time to shortchange doctors, clinics, or patients.

Last Updated on Friday, May 30, 2014 8:48 PM
 

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