publication date: Apr. 4, 2014


Oncologists Tell Congress Community Cancer Practices Are Not Adequately Reimbursed

Current Medicare policies do not adequately reimburse cancer care provided in the community setting, the Community Oncology Alliance and the U.S. Oncology Network said in a joint, open letter to members of Congress.

The two organizations cited closures of community cancer clinics, mergers with large hospitals, and increasing barriers to accessing care in rural areas as results of current Medicare policy, which, according to the two organizations, incentivizes care provided in more expensive hospital outpatient departments while also increasing costs for the program and for seniors with cancer.

“We are truly in crisis mode,” said Mark Thompson, president of COA. “Coupled with sequestration cuts that reduce reimbursement for costly cancer-fighting drugs, we’re at a breaking point, and seniors with cancer will suffer most.”

Over the past six years, 288 treatment facilities have closed and 469 practices, typically having multiple treatment facilities, have been forced to merge or affiliate with hospitals, according to data collected by COA. In 2005, 87 percent of chemotherapy was administered in community cancer clinics, but by the end of 2011, that number declined to 67 percent.

COA says that cancer care delivered in hospital outpatient departments costs Medicare $6,500 more per beneficiary on an annualized basis compared to care provided in physician-run community cancer clinics. Hospital-based care also costs seniors $650 more in out-of-pocket copayments compared to community-based care.

“Congress must act immediately to stabilize the community cancer care delivery system in any Medicare legislation before the shift of cancer care to the more expensive hospital setting becomes irreversible,” the letter reads. “Members of Congress on both sides of the aisle recognize this threat and have sponsored legislation to stop [Centers for Medicare & Medicaid Services] application of the sequester cut to cancer drugs (H.R. 1416), to fix the prompt pay problem that artificially lowers cancer drug payments (H.R. 800 and S. 806), and to adopt site-neutral payments for outpatient cancer care services (H.R. 2869).”

Community providers are asking Congress to create payment parity across sites of service, as recommended by the Medicare Payment Advisory Commission. Providers are also asking Congress to address the reimbursement mechanism for cancer drugs, which does not cover the full cost of acquiring, handing, storing and disposing of medications and has been further impacted by sequestration.

The full letter is available on The Cancer Letter website.

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