As resolution on the health care reform process seems to be drawing near in Washington, the sand is running out of the hourglass for Medicare, already projected to be insolvent by 2017. The system significantly underpays physicians for necessary services to Medicare beneficiaries. Over the past 20 years, Congress has expanded Medicare benefits and authorized payment for important new technologies at the expense of physician services.
Each year, a flawed formula known as the Sustainable Growth Rate (SGR) is used to calculate Medicare payments for physician services. Over the past several years, the growing negative calculation has also incentivized Congress to override it with a last minute "patch" to the fee schedule – further sustaining insufficient reimbursement and only for short periods of time. The latest patch expires on March 31, when Medicare reimbursement to all physicians will be cut 21.2 percent.
Congress is merely kicking the can down the road, ignoring a solution to appropriately reimburse physician providers for their services to Medicare beneficiaries. As a result, each year it is increasingly difficult for physicians to provide patients with what they desire most: access to concerned, thoughtful physicians, who can guarantee the right tests or treatment, at the right time and right place, effectively and efficiently.
An important example of the crisis is in the delivery of cancer care. Cancer has remained a formidable foe for modern medicine; however, the past decade has witnessed vast advances in the treatment of the disease. We are now seeing substantial declines in the incidence rates and significant improvements in the survival rates of cancer. The United States leads the Western world in the best survival statistics. The success is not attributable to any one measure, but through myriad advances in a delicate and complex delivery system that includes healthier lifestyles, prevention, screening, diagnostic technology and treatment modalities.
Medicare covers most of these, and has adopted a payment system that updates the payment for costly pharmaceuticals four times per year, often costing tens of thousands of dollars. Yet, Medicare significantly underpays for physician services needed to safely administer complex cancer treatments. Preliminary results of a recent national survey indicate that Medicare pays just 56 percent of the cost of administering complex chemotherapy services in community cancer centers. Although the Medicare payment system "allows" payment for the cost of chemotherapy drugs, it only pays 80 percent, resulting in prohibitive co-payments for Medicare patients who do not have co-insurance.
Compared to the "donut hole" in the Medicare Prescription Drug Payment system, these co-payments represent a "black hole" for Medicare patients and providers. To add insult to injury, the CMS Physician Payment Schedule for 2010 and beyond cuts even deeper, reducing payment for chemotherapy administration services an additional five percent annually, up to 20 percent by 2013. There are additional cuts for cancer diagnostic imaging and physician consultation services.
The CMS cuts threaten cancer patients’ access to what is currently the best cancer care delivery system in the world. The current Health Care Reform bills do nothing to avert this crisis. Congress should fix Medicare first and stop the Cancer care cuts.
Patrick Cobb, M.D., president of Community Oncology Alliance (COA) and managing partner of Hematology-Oncology Centers of the Northern Rockies in Billings, Montana