Lawmakers seek postponement of Medicare pay cuts for cancer care

A 6.1% decrease in the 2011 fee schedule would financially strain oncologists' practices, House members say in a letter to HHS Secretary Sebelius.

By Chris Silva — Posted Oct. 22, 2010

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Some lawmakers are helping the oncology community in its campaign to halt Medicare pay cuts for cancer care services, reductions above and beyond the scheduled Medicare pay cut that all physicians face.

Rep. Steve Israel (D, N.Y.) and 85 other House members sent a letter Sept. 30 to Health and Human Services Secretary Kathleen Sebelius asking for additional cuts to be postponed.

Since 2004, payments for chemotherapy administration have been cut by about 35%, while costs of operating a medical practice have increased, according to the Community Oncology Alliance, a Washington, D.C.-based nonprofit that advocates on behalf of cancer care delivery.

The Centers for Medicare & Medicaid Services published its proposed 2011 Medicare fee schedule on July 13. It would implement provisions in the national health reform law that eliminate out-of-pocket costs for beneficiaries for most preventive services, including a new annual primary care visit benefit.

But it also projects a 6.1% reduction to physician payment rates in 2011, as mandated under the sustainable growth rate formula. That's on top of an approximate 23% cut planned for the end of November.

"We have made significant strides in treating cancer in this country, and Americans receive better cancer care than anywhere else in the world," said David Eagle, MD, in an Oct. 6 statement. He is COA's president and a partner at Lake Norman Hematology Oncology Specialists in Mooresville, N.C. "[But] community oncology cannot withstand yet another reimbursement cut and continue to deliver cutting-edge care. Our progress will be lost and patients will suffer if the proposed cuts are implemented."

American Society of Clinical Oncology leaders commended lawmakers for their efforts to halt cuts that they say threaten to devastate the system of care that more than 50% of cancer patients in the United States depend upon. "If the sustainable growth rate formula takes effect in its current form, physicians will be facing an additional cut of almost 30% in 2011. To preserve patients' access to cancer care within their own community, Congress must repeal the sustainable growth rate formula for a new system that pays oncologists and all physicians directly and fairly for all of the services involved in treating Medicare patients," said Allen S. Lichter, MD, CEO of the society.

The lawmakers said they are alarmed because of an increasing number of community care cancer centers that have reported struggling financially, including some that have closed and others that have turned patients away.

"The impact of cuts to cancer care in the proposed 2011 physician fee schedule concerns us greatly," said the letter, which also was addressed to CMS Administrator Donald Berwick, MD. "Community cancer care clinics ... have already been adversely affected by previously implemented cuts, and a further reduction in Medicare reimbursement for these providers could result in fewer options for patients or higher costs."

CMS is expected to issue a final rule on or about Nov. 1.

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