For Medicare beneficiaries, the anticipated damage from these looming cuts became all the more real with the release of a report this month from the American Hospital Association (AHA), American Medical Association (AMA) and American Nurses Association (ANA) predicting the loss of 496,000 jobs next year and more than 766,000 jobs by 2021 as a result of the scheduled 2 percent cut to Medicare under sequestration. The concerns raised in this report were strengthened by the recent White House release of additional details regarding sequestration cuts to various health care programs and services, which include a whopping $11.1 billion cut to Medicare in fiscal 2013 alone.
Although the AHA, AMA and ANA report warns of the economic ramifications of the cuts to Medicare, it repeats the Obama administration’s refrain that sequestration cuts will impact Medicare providers, not beneficiaries themselves – a line of thinking that is unfounded and short-sighted. As the National Patient Advocate Foundation and the patients served by our companion organization Patient Advocate Foundation (PAF) have seen time and again, when providers are strained, patients themselves feel the brunt of the impact. Financially overburdened facilities are often forced to forgo needed technology investments, limit services, and in many situations, close altogether. It stands to reason that patients will be affected by these outcomes.
Approximately one in four of the 103,112 patients served by PAF in 2011 were Medicare beneficiaries, representing the single largest payer group receiving assistance. Within the Medicare patients served last year, cancer was the top health condition reported; chronic and/or debilitating conditions comprised the second category; and autoimmune diseases the third. One-third of these patients reported the presence of multiple health conditions, which can further complicate care coordination and affordability. Two-thirds of them reported a household income of less than $23,000 with the inability to afford transportation to and from service providers the primary issue that led to their debt crisis. Overall, debt crisis/cost of living issues comprised 30.3 percent of the issues reported. It is this population -- the aged, poor, often isolated and underserved -- that PAF strives to pay particular attention to, as cuts in provider services are most likely to result in outcomes that make it especially difficult for these patients to receive care.
Take a look at cancer care, where approximately 80 percent of care is delivered in community oncology clinics. The Community Oncology Alliance reports that due to funding challenges, 199 community-based cancer clinics have closed in the past three years and 369 practices, with multiple clinic locations, are struggling to stay open. When a local community clinic no longer accepts Medicare patients or is forced to close, the provider is often absorbed into urban hospital systems. This shift of care to more urban settings often represents an access to care challenge for patients. Not only does it require elderly, sick patients to travel longer distances to receive care, it also seriously diminishes quality of life. Patients are forced to arrange travel to the hospital and oftentimes patients are too weak after treatment to get back in a car and return home. The cost of lodging, in addition to transportation is an expense that patients simply cannot afford, especially those residing in rural communities.
Although the cuts to Medicare under sequestration are devastating on their own, health care providers are also concurrently dealing with a multitude of very real economic pressures that are adding intense burden and likely to influence their selection of patients. These include the ongoing threat of significant reimbursement cuts for services to Medicare beneficiaries under the Sustainable Growth Rate – currently scheduled to deliver a 27 percent cut January 1 – and outcomes from the Patient Protection and Affordable Care Act such as additional cuts in Medicare, decreased payments to specialists, and private payer shifting of preferred providers.
As disheartening as it is to consider that we are putting our physicians in this increasingly difficult scenario, ultimately it is the vulnerable patients on Medicare seeking care who will pay the greatest price.
Though we continue to await the details of what the Medicare provider cuts under sequestration will entail, we must be realistic and recognize that these funding cuts will affect providers and their patients alike. With continued infighting and a lame duck session this fall, it seems that sequestration cannot be avoided. But for the sake of America’s Medicare beneficiaries and the other Americans dependent upon quality, accessible health care, we must work together to reverse this action, ensure community-based medical facilities remain solvent, and protect access to health care for current and future generations of seniors.
Davenport-Ennis is the founder and CEO of the National Patient Advocate Foundation and a two-time breast cancer survivor.