Action on patient safety will help achieve the health care system we deserve
The Trump administration’s absurd devaluing of cancer care for seniors
Let me take you into my exam room when I had to give my 75-year-old patient, "Mrs. Simpson" (a real patient's case but using a pseudonym for privacy), the terrible news that she has multiple myeloma. Her case underscores the absurdity of the Trump administration's recent proposal to pay the same amount to providers to evaluate and manage a patient with the sniffles, as they would to manage Mrs. Simpson's complicated cancer.
Triggered by a low white blood cell count, I had found an abnormal protein in Mrs. Simpson's blood and then performed a bone marrow biopsy. Nothing in the recently proposed Centers for Medicare & Medicaid Services (CMS) 2019 Physician Fee Schedule would impact her care, so far. But, going forward, we would enter the post-diagnosis evaluation and management (E&M) phase of her care, and the irrationality of the CMS proposal was quickly apparent.
Starting in 2019, CMS has proposed drastically cutting E&M reimbursement for complex cancer cases by 22 percent for a new patient and 37 percent for existing patients. Oncologists and other specialists aren't mad about yet another Medicare pay cut - although that does sting - we are insulted that CMS thinks the time and expertise of physicians who treat cancer and other incredibly complex diseases is worthless. Worse yet, this cut is an affront to seniors in the Medicare program who expect, have paid for, and deserve that expertise and time in caring for their complex medical conditions.
CMS Administrator Seema Verma said in a letter to physicians that the proposal will "dramatically reduce the amount of time you have to spend inputting unnecessary information into your patient's records." Because of the new proposed pay scheme, physicians would spend less time, "copying, pasting, and clicking."
Is that what she thinks we do all day?
If Administrator Verma shadowed me in the exam room for the first evaluation and management visit of Mrs. Simpson's care, which lasted nearly an hour, she would understand the reality of specialty medical care. The "clicking," is minimal - and just the tip of the iceberg of what we do.
After breaking the cancer diagnosis to Mrs. Simpson, I walked her through why she needed a PET scan to get a better look at how the cancer is behaving. I also explained why she needed to see a bone marrow transplant physician - something that's fairly typical with blood cancer - and helped schedule that appointment. Then, we reviewed the current therapies for her disease, the need for chromosomal testing to guide treatment decisions, and went over the schedule of initial therapy. Finally, and the most difficult part of all, we sat down and discussed her life expectancy.
After receiving this devastating news most patients, like Mrs. Simpson, will call their oncologists back with a number of additional questions. Of course, we take those calls, answer the questions, and explain how we will best manage and face this cancer together.
The Trump administration now wants to completely devalue my expertise and time, giving the treatment of a complex case of cancer the same value as a case of the sniffles. It is simply ludicrous.
What is especially perplexing is that the proposal comes at a time when CMS wants to move physicians towards "value-based" models of health care, such as with the ongoing Oncology Care Model (OCM). A mainstay of these "quality" reforms is encouraging physicians to spend more time managing complex patients, not less. But the message we are getting from CMS' E&M cut is that they are more interested in the quantity of patient care, not the quality of patient care.
Community oncologists like me appreciate Administrator Verma's focus on reducing Medicare bureaucracy and documentation requirements so that we can dedicate more time to patient care. However, this proposal completely fails to do that and will shortchange seniors like Mrs. Simpson who are struggling with cancer and other complex diseases.
CMS must withdraw this absurd proposal, get out of the Washington, D.C. bubble, and understand how to truly improve Medicare in a way that values - not devalues - the quality medical care specialists provide to seniors with cancer and other complex conditions.
Jeffrey Vacirca, MD, FACP is a board-certified hematologist and oncologist at New York Cancer & Blood Specialists, where he serves as CEO and managing partner. He is also the current president of the Community Oncology Alliance.