Cancer Patients Get A Reprieve From Threatened Medicare Cutbacks

By Steve Bigham

Cancer patients and physicians are breathing a sigh of relief now that Congress has decided to postpone passage of a bill that could have wiped out most outpatient cancer treatment facilities, particularly those that serve Medicare patients.

Thanks in large part to groups like the Association of Community Cancer Centers (ACCC), the federal government has decided not to go forward with plans to apply a 2.5 percent hospital outpatient payment cap to drugs and other services in 2001.

As of January 1, 2001, the Health Care Financing Administration (HCFA) was expected to cut Medicare reimbursements for outpatient cancer treatments by as much as 50 percent. It was slated to raise benefits to only those approved cancer centers around the county… and there are only about 30 of them – three in the tri-state area.

In a major development, House Ways and Means Health Subcommittee Chair Rep William Thomas of California reached an agreement with HCFA that would forestall a 50 percent cut in pass-through payments for new medical technologies under Medicare’s hospital outpatient prospective system. Congress is expected to address the issue again next year.

Oncologists were heartened by the decision. They say they rely on these reimbursements to stay in business. The passage of the bill would have lead to the closing of facilities that provide chemotherapy treatments close to home. Cancer patients would have had to huff it down to New York City for treatment.

Newtown resident John Rohmer is one of the lucky ones. His oncologist promised not to close the doors on him no matter how much the government cutbacks turned out to be. And while the government has put a hold on the plan, Mr Rohmer worries about future patients who may be affected should the government change its mind again.

Sure, says Mr Rohmer, some small hospitals may still be able to provide less-effective care, but only NYU, Columbia, and Sloan-Kettering hospitals will be able to provide the kind of healthcare coverage so many need. As he points out, the proposed cuts would have had a devastating impact on Medicare beneficiaries’ access to new therapies and would have forced community-based cancer research programs to curtail services.

 Mr Rohmer’s oncologist, Gino Bottino, MD, operates an outpatient chemotherapy facility in Mount Kisco, N.Y., where he provides patients with chemotherapy treatment. Until now, he was able to purchase drugs at a price that was less than what Medicare was reimbursing him for. The government’s proposed cuts would have put his business in jeopardy and risked putting added strain on cancer patients nationwide.

“This situation leaves patients like myself with real questions about our future,” Mr Rohmer said.

The HCFA, which regulates Medicare payments, contends doctors are making too much money on the spread between the wholesale prices they pay and the prices in which they are being reimbursed by Medicare.

“If this goes through, we won’t be able to treat our Medicare patients,” noted Evelyn Rodgriquez, who heads the billing department in Dr Bottino’s office. “Some of the proposals would have us paid less than what we pay out of pocket for drugs. Currently, Medicare reimburses 96 percent of wholesale prices.”

According to Mrs Rodriquez, the HCFA is targeting those drugs that are considered to be on the “money-makers” list.

“If someone is currently on that treatment, we would have had to give them something that’s not on the list or send them to the hospital for treatment,” Mrs Rodriquez explained.

The impact of the proposed cut would have been dramatic for Medicare beneficiaries with cancer. Nearly 30 percent of all Medicare beneficiaries, including some of the most complex and difficult cases, are seen in the cancer center setting. It has been estimated that reimbursement for cancer drugs would have been cut by more than 25 percent under the original proposal. If this were the case, cancer programs would have faced severe losses on each Medicare patient they treat.

Some of the credit for the government’s change of mind should go to people like John Rohmer, who was diagnosed with inoperable prostate cancer in 1995. Mr Rohmer, who has maintained a positive prospectus on his illness, has written numerous letters to politicians in Congress urging them to reconsider the proposal to cut Medicare reimbursements.