Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)

Cancer clinics are turning away thousands of Medicare patients. Blame the sequester.

Posted by on Apr. 4, 2013 at 1:57 PM
  • 12 Replies


Cancer clinics across the country have begun turning away thousands of Medicare patients, blaming the sequester budget cuts.

Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.

Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.

“If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year,” said Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates in New York. “The drugs we’re going to lose money on we’re not going to administer right now.”

After an emergency meeting Tuesday, Vacirca’s clinics decided that they would no longer see one-third of their 16,000 Medicare patients.

“A lot of us are in disbelief that this is happening,” he said. “It’s a choice between seeing these patients and staying in business.”

Some who have been pushing the federal government to spend less on health care say this is not the right approach.

“I don’t think there was an intention to disrupt care or move it into a more expensive setting,” said Cathy Schoen, senior vice president of the Commonwealth Fund, which recently released a plan for cutting $2 trillion in health spending. “If that’s the case, we’re being  penny-wise and a pound-foolish with these cuts.”

Legislators meant to partially shield Medicare from the automatic budget cuts triggered by the sequester, limiting the program to a 2 percent reduction — a fraction of the cuts seen by other federal programs.

But oncologists say the cut is unexpectedly damaging for cancer patients because of the way those treatments are covered.

Medications for seniors are usually covered under the optional Medicare Part D, which includes private insurance. But because cancer drugs must be administered by a physician, they are among a handful of pharmaceuticals paid for by Part B, which covers doctor visits and is subject to the sequester cut.

The federal government typically pays community oncologists for the average sales price of a chemotherapy drug, plus 6 percent to cover the cost of storing and administering the medication.

Since oncologists cannot change the drug prices, they argue that the entire 2 percent cut will have to come out of that 6 percent overhead. That would make it more akin to a double-digit pay cut.

“If you get cut on the service side, you can either absorb it or make do with fewer nurses,” said Ted Okon, director of the Community Oncology Alliance, which advocates for hundreds of cancer clinics nationwide. “This is a drug that we’re purchasing. The costs don’t change and you can’t do without it. There isn’t really wiggle room.”

Okon’s group has sent letters to legislators urging them to exempt cancer drugs from the sequester or, as a back-up, only shave 2 percent off the money they receive to administer the medications.

Doctors at the Charleston Cancer Center in South Carolina began informing patients weeks ago that, due to the sequester cuts, they would soon need to seek treatment elsewhere.

“We don’t sugar-coat things, we’re cancer doctors,” Charles Holladay, a doctor at the clinic, said. “We tell them that if we don’t go this course, it’s just a matter of time before we go out of business.”

Cancer patients turned away from local oncology clinics may seek care at hospitals, which also deliver chemotherapy treatments.

The care will likely be more expensive: One study from actuarial firm Milliman found that chemotherapy delivered in a hospital setting costs the federal government an average of $6,500 more annually than care delivered in a community clinic.

Those costs can trickle down to patients, who are responsible for picking up a certain amount of the medical bills. Milliman found that Medicare patients ended up with an average of $650 more in out-of-pocket costs when they were seen only in a hospital setting.

It is still unclear whether hospitals have the capacity to absorb these patients. The same Milliman report found that the majority of Medicare patients — 66 percent — receive treatment in a community oncology clinic, instead of a hospital.

Non-profit hospitals will likely have an easier time bearing the brunt of the sequester cuts. A federal program known as 340B requires pharmaceutical companies to give double-digit discounts to hospitals that treat low-income and uninsured patients.

Eastern Connecticut Health Network began preparing for additional volume after a local oncology practice sent out notice that it would stop seeing certain cancer patients.

“What we’re trying to do in the hospital is prepare for this,” ECHN spokesman Eric Berthel said. “We’re making sure we have access to the pharmaceutical companies and that we have appropriate staff on hand. We’re hoping the oncology practice will be successful in renegotiating this. It’s so fresh, so we’re pretty unsure.”

Some cancer clinics are counting on the federal government to provide relief, and continuing to see patients they expect to lose money on.

“We’re hoping that something will change, as legislators see the impact of this,” Ralph Boccia, director of the Center for Cancer and Blood Disorders in Bethesda, Md., said. “I don’t think we could keep going, without a change, for more than a couple of months.”

An analysis prepared by his clinic estimates that, if the full 2 percent cut takes effect, between 50 and 70 percent of the drugs it administers would become money losers.

Boccia estimates that 55 percent of his patients are covered by Medicare, making any changes to reimbursement rates difficult to weather.

“When I look at the numbers, they don’t add up,” he said. “Business 101 says we can’t stay open if we don’t cover our costs.”

source

by on Apr. 4, 2013 at 1:57 PM
Add your quick reply below:
You must be a member to reply to this post.
Replies (1-10):
LucyMom08
by Gold Member on Apr. 4, 2013 at 2:06 PM
3 moms liked this

 If those whiny babies on Capitol Hill could actually learn to do their jobs, we wouldn't be having these major issues...instead, all they do is point fingers and try to 'win' at something that making us all losers...and it's hurting us all in the process...

brookiecookie87
by Platinum Member on Apr. 4, 2013 at 2:12 PM
3 moms liked this



Quoting LucyMom08:

 If those whiny babies on Capitol Hill could actually learn to do their jobs, we wouldn't be having these major issues...instead, all they do is point fingers and try to 'win' at something that making us all losers...and it's hurting us all in the process...

I completely agree.

Republicans/Democrats are fighting each other tooth and nail it seems. The real loser here is the American people.

Which is why I believe our country needs to do away with this two party system. Clearly it doesn't work.  We need to change it up so either there are multiple parties or so that there are no parties and the people who help america the most are the ones who are voted to the top based on what they have done for america. This way people would fight to make america the best it can. And the moment someone stops focusing on america and starts focusing on himself he can be voted out.

Currently this doesn't happen. Republicans will vote republicans. Democrats will vote democrat. Very little will change that in our current system.


Join us on the 99% Moms group!
The Ninety-Nine Percent Moms   

If they enforced bank regulations like they do park rules, we wouldn't be in this mess

tooptimistic
by Kelly on Apr. 4, 2013 at 2:15 PM
7 moms liked this

This is why we need universal healthcare.

Goodwoman614
by Satan on Apr. 4, 2013 at 2:18 PM
1 mom liked this

But it's really Repug obstructionism.

TranquilMind
by Platinum Member on Apr. 4, 2013 at 4:55 PM
1 mom liked this

Oh yes, this is totally coming in a wave in every area.   Who could possibly afford hospital treatments?  You know hospitals quadruple X 100-charge everything. 

 

brookiecookie87
by Platinum Member on Apr. 4, 2013 at 4:57 PM



Quoting TranquilMind:

Oh yes, this is totally coming in a wave in every area.   Who could possibly afford hospital treatments?  You know hospitals quadruple X 100-charge everything. 

Glad to see a topic we finally agree on.


Join us on the 99% Moms group!
The Ninety-Nine Percent Moms   

If they enforced bank regulations like they do park rules, we wouldn't be in this mess

TranquilMind
by Platinum Member on Apr. 4, 2013 at 4:57 PM

 Alert the media!

I don't think it has ever happened before.


Quoting brookiecookie87:

 

 

Quoting TranquilMind:

Oh yes, this is totally coming in a wave in every area.   Who could possibly afford hospital treatments?  You know hospitals quadruple X 100-charge everything. 

Glad to see a topic we finally agree on.

 


 

stacymomof2
by Ruby Member on Apr. 4, 2013 at 5:08 PM
3 moms liked this

This speaks to me because my dad has cancer and is currently under private insurace, but will qualify for medicare at the end of next month.  His treatments are SEVERAL THOUSAND per treatment.  I don't even need to tell you what his private insurance costs.  He has worked and saved his whole life and now (because of a corrupt company who poisoned him) he should either die untreated or bankrupt my mom?  It's fucking sick, the state of healthcare in this country.  Of course the private insurance is insisting he apply for medicare...can you believe that is legal?  He is contracted to apply for medicare to make the government the primary payee.  That is the deal with private insurance.  They make it a requirement.  How is that a reasonable (or legal!) business model to make it part of the contract that the US Government has to be the primary payee, yet they have been collecting tens of thousands of dollars a year for 20 or so years to cover him?  Since before he had cancer?  Why should this insurance company take premium payments and then insist the government has to pay?  It's a fucking racket.

The point is that everyone who loves to say that people is this country should pay out of pocket for treatment is completely not understanding the issue.  We either take care of our people or let them die.  What side are you on?

LilliesValley
by Bronze Member on Apr. 4, 2013 at 6:09 PM
1 mom liked this
And yet these stupid elected officials get healthcare still. Give them no benefits, salary, security, and healthcare and I think reform would happen really fast. Want a bunch of shit. They should all lose their benefits all of them. Sitting on their asses and taking vacations on our dime while people are dying. Stupid fuckers.
Posted on the NEW CafeMom Mobile
GoddessNDaRuff
by Silver Member on Apr. 4, 2013 at 6:35 PM
You do realize this has been happening for awhile now. Not just cancer patients but dialysis as well. First, it was just medicare funding issues, the obamacare, and now the sequester.
Posted on the NEW CafeMom Mobile
Add your quick reply below:
You must be a member to reply to this post.
Join the Meeting Place for Moms!
Talk to other moms, share advice, and have fun!

(minimum 6 characters)



Featured