Background Information

  ·    80% of all cancer care occurs in community cancer centers (private practices and freestanding cancer centers, not the hospital).<!--[if !supportFootnotes]-->[1]<!--[endif]-->

  ·    60% of all new cancer diagnoses are made in Medicare beneficiaries.

  ·    Medicare reimbursement rules were created when most chemotherapy occurred in the hospital.

  ·    Outpatient chemotherapy evolved in an effort to reduce the overall cost of cancer care.

  ·    Currently, Medicare overpays for chemotherapy drugs by $570 million per year. However, it currently underpays for the essential services (such as infusing the medication) by $718 million annually. So Medicare currently underpays oncologists by $148 million per year.<!--[if !supportFootnotes]-->[2]<!--[endif]-->

  ·    Medicare beneficiaries are required to pay 20% of the cost of their care. Many cannot afford to do so. In those cases, they are usually treated regardless of their ability to pay, costing community cancer clinics an additional $200 million or more in free cancer care.

  ·    Cancer death rates have declined over the last five years.

  ·    In 2002, cancer cost about $171.6 billion; $60.9 billion in direct costs, $15.5 billion in indirect costs due to illness and $95.2 billion in indirect costs due to premature death.<!--[if !supportFootnotes]-->[3]<!--[endif]-->

  ·    In the United States, men have about a 1 in 2 chance of developing cancer. Women have about a 1 in 3 chance of developing cancer.<!--[if !supportFootnotes]-->[3]<!--[endif]-->

  ·    This year, 556,000 people in the United States are expected to die from cancer, about 1,500 each day.<!--[if !supportFootnotes]-->[3]<!--[endif]-->

Provisions in the Proposed Medicare Legislation

The Senate and House bills differ in how they cut cancer care. However, both would cut $16 billion from cancer care reimbursement over 10 years, a reduction of about 30%.<!--[if !supportFootnotes]-->[4]<!--[endif]--> Although $16 billion seems like a huge cost, spread over the entire US population, the cost of paying for this cut equals about 1.5 cents per American per day over 10 years.

 House Bill

·      Requires a third party pharmacy chosen by the government to deliver prescribed drugs, called mandatory vendor imposition (MVI).<!--[if !supportFootnotes]-->[4]<!--[endif]-->

·      In some cases, cancer patients would be required to pick up their medication and bring it to their doctor’s office for administration.

·      Patients will have to return to the office at least one day after their chemotherapy drugs are prescribed to receive the treatment; this will require two separate pre-treatment medical evaluations.

 Senate Bill

·      Decreases chemotherapy reimbursement from 95% to 85% without increasing the payments for chemotherapy-related services.<!--[if !supportFootnotes]-->[4]<!--[endif]-->

Implications of the Proposed Medicare Legislation

Although these changes seem harmless, they will have a huge impact on cancer care in America.

·      Practices cannot continue to operate at a loss for very long. Community oncologists would have to cut costs in one of three ways:

o     Make severe cuts in patient care (by cutting highly skilled nurses and other clinicians)

o     Stop treating Medicare patients

o     Close satellite and/or main offices.

·      Any of these strategies will severely limit access to life-saving and life-prolonging treatment for our sickest Medicare patients. If oncology practices cannot give chemotherapy, cancer patients must:

o     Receive chemotherapy in the hospital

o     Receive chemotherapy and cancer care in university medical centers

o     Forgo cancer treatment.

·      Receiving chemotherapy in the hospital may harm cancer patients because:

o     Being admitted to the hospital for chemotherapy adds several hours onto an already exhausting day for a weak, tired, sick patient. It may also increase travel time significantly.

o     Hospitals have more serious bacteria than homes, in greater numbers. Cancer patients have severely weakened immune systems from chemotherapy and are much more susceptible to infection. Serious infections lead to long, expensive hospital admissions.

o     Hospital nursing teams are notoriously understaffed and overburdened, each caring for more patients than outpatient chemotherapy nurses. Chemotherapy is extremely toxic; patients need close monitoring during their 2-8 hour infusions. Some patients have life-threatening reactions to chemo requiring resuscitation by a doctor who may not be available in the hospital.

o     Hospitals are already overflowing with more patients than they can handle. They cannot care for five times as many patients as they currently treat. Those additional patients they can treat will have to wait for treatment, leading to less effective cancer treatment.

o     Hospitals already lose money on inpatient chemotherapy. Treating more patients at a loss will ultimately force them to either stop providing chemotherapy or close.

·      The MVI provision in the House bill is also harmful for cancer patients. The system would:

o     Cause treatment delays

o     Require patients to have multiple visits and multiple co-pays and in some cases pick up their medication and bring it to their doctor’s office.

o     Possibly lead to substandard chemotherapy due to improper storage, mixing, or transport.