Midlands Voices: Cuts in Medicare threaten high quality of cancer care

The writer, an oncologist, lives in Omaha.

While the debate on health care reform continues, there is another problem brewing: The Center for Medicare and Medicaid Services (CMS) will cut payments for each of the major components of cancer diagnosis and care — chemotherapy, consultations, diagnostic imaging and therapeutic radiation — in 2010.

Starting next month, payment for the administration of life-saving cancer drugs will be cut by 5 percent, with further cuts increasing to almost 20 percent by 2013. A disaster in cancer care delivery is imminent.

Cuts in Medicare reimbursement to oncologists for cancer drug administration have occurred every year since 2004, totaling more than 25 percent from 2004 to 2009. Estimates are that about half of the essential services provided by community cancer facilities are not even reimbursed at all.

Making this bad situation worse, CMS also is scheduled to cut physician-related Medicare payments for all physicians by an additional 21.2 percent, effective on Jan. 1.

These drastic reductions in Medicare reimbursement will undermine the quality and the availability of medical care for cancer patients in this country. More cuts to Medicare, which provides care for 45 percent of all cancer patients, will jeopardize access to cancer care rivaled only by the crisis of the uninsured.

While some may suspect this is merely a case of already overpaid doctors wanting to protect their interests, I can only share the challenging situation of my own practice.

Medicare currently reimburses us at less than our acquisition cost for nearly half of the cancer drugs we administer. If the difference is small, we are able to treat the patient in our office. But if the difference is large or the patient has no Medicare supplemental insurance, we are forced to refer him or her to the hospital for chemotherapy. Some of the rural hospitals we deal with also do not have the wherewithal to treat these patients.

We are willing to give away our time, but we cannot afford to give away expensive cancer drugs forever. If we did, we would be out of business.

This ethical dilemma weighs heavily on our doctors, nurses and staff. It is getting harder and harder both financially and emotionally for us to do our jobs.

Fixing the broken Medicare payment system is an essential element of comprehensive health care reform. But Congress also must fix the flaws in the Medicare reimbursement for cancer care.

If not, the United States will no longer have the best cancer survival statistics and best access to cancer care in the world that it enjoys today.

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