For diseases such as cancer, rheumatoid arthritis, and multiple sclerosis, the prescribed treatment regimens generally are infused or injected therapies and require physician supervision for the sake of safety and efficacy.
Under the current system, physicians pay for these drugs themselves, treat the beneficiary, and then bill Medicare. They are then paid under a formula -- roughly, the prevailing average market-based price of the drug plus a percentage add-on to cover administrative costs.
Caught up in the push for a federal fiscal clampdown, Congress is looking to slash Part B's reimbursement rates for a select group of doctors, chiefly oncologists, rheumatologists, and other specialists who use these medicines as key components of treating diseases.
These so-called "savings" would come at a huge cost to patient health -- and the healthcare system generally. And the hits would fall heaviest on people living in rural America.
Many doctors already face no or very small margins when treating Part B patients. MedPAC has described these margins as "slim" for most doctors and notes that there are even "some drugs [physicians] cannot purchase at the payment rate” because it's already too low.
For many doctors, further cuts to Part B reimbursements would make it completely financially unsustainable for them to continue to treat patients. In an understandable effort to stay afloat, many will restrict the number of new enrollees they treat or opt out of Medicare entirely. Available clinics will dry up. And patients will face longer wait times, extended travel times to receive treatment at regional medical centers instead of their communities, restricted access to care, and additional risks to their health.
These effects are going to be felt everywhere. But they will be particularly pronounced in rural areas. Small, rural clinics face higher drug acquisition costs than their big-city counterparts. That means these doctors will have little room to maneuver if rate cuts go into effect.
If the Part B rate drops, they'll face tough choices about whether they can continue to afford providing these treatments – or send their patients elsewhere, often hundreds of miles away to the nearest big-city hospital.
Nationwide, community cancer clinics are already in a financially tough spot. Research shows that in the past five years, about 240 clinics have closed. Another 450 are facing severe financial difficulties.
If community clinics close down or scale back operations, local patients will suffer a huge jump in wait times. The Duke University Clinical Research Institute has already found that reimbursement cuts imposed in 2003 extended the period between diagnosis and chemotherapy by five times for the average cancer patient in a rural community. Can we afford for this concerning situation to get worse?
It's understandable that federal lawmakers are looking for ways to cut costs. But the problem of spiraling national debt can and must be addressed without jeopardizing the health care of vulnerable patient populations. There’s no evidence or research to show that Part B rates are too high, and healthcare providers in rural communities are already facing tough financial times. Slashing Part B reimbursements would drive many of them out of business and leave local patients with nowhere to go.
Luttrell is president of the National Grange.