Community Oncology Alliance

Community oncology practice administrators from around the country recently met with CMS in Washington, DC.

As community oncology practice administrators, we are writing to all in community oncology to tell you about our recent meeting at the Centers for Medicare & Medicaid Services (CMS). This meeting opened our eyes and we are calling upon all in the community who read this to join us in a massive outreach to our Representatives and Senators in Congress.

If we are not engaged as a community, we face drastic reimbursement cuts to Medicare in several areas.

We will keep this brief. If you would like to know more, please click on our names to send us an email.

The Meeting

The meeting with CMS took place at HHS headquarters in Washington, DC and was actually set up by congressional staff. Having staff involved and at the meeting was important because they heard our presentations to CMS.

As you know, CMS is planning drastic cuts to Medicare payment for drug administration, consultations, diagnostic imaging, and therapeutic radiation. Individually, we presented data refuting CMS’ conclusions that the cost of treating cancer patients has decreased substantially. Additionally, we related the impact that Medicare reimbursement cuts have had to date and our projections on the impact of the proposed cuts. During the meeting, Dr. David Eagle, a practicing oncologist and lead physician on the Components of Care study, presented preliminary conclusions that document that Medicare pays for only 56% of the cost of care we provide.

“Our organization has already made changes to adapt to the current state of reimbursement for oncology. We have eliminated staff and work hours and negotiated higher rates with private payers in an attempt to cover loses we face when treating Medicare patients. If we incur further Medicare cuts in 2010, we will have to make further cuts in costs that will start to dramatically affect our ability to retain staff including nurse practitioners and physicians. Unfortunately, there is no where else for these patients to go. The hospitals are not prepared to treat these patients, the academic centers have long waits, and patients in surrounding rural areas are losing options to access care and are seeking out care in our city. Further cuts to an already stressed system, facing access issues, need to be reversed.”
Glenn Balasky
The Mark H. Zangmeister Center
Columbus, Ohio

“To severely cut reimbursement at a time when oncology offices are struggling to stay afloat while the number of oncology patients is increasing, is a short term fix for a real disaster for Medicare oncology patients — especially in rural areas.”
Margaret V. Beazley
Cancer Care of WNC, PA
Asheville, North Carolina

“45% of our patient base is Medicare. If all of these Medicare patients were Medicare Advantage patients or Medicare patients without secondary coverage, we would not receive enough reimbursement between the drug reimbursement AND the infusion reimbursement to cover the cost of the drug therapy for 55% of our breast cancer regimens. And from the patient’s perspective, these same breast cancer patients currently spend an average of 53% of their entire month of Social Security income to cover the average co-insurance amount for a single month of breast cancer therapy. This leaves little else for food, shelter or other essentials.”
Bo Gamble
Southeastern Medical Oncology Center
Goldsboro, North Carolina

“As an oncology nurse and an administrator, I am concerned about the changes physicians are making in their private practices to adapt to decreasing reimbursement that could seriously affect patient care and safety. I am even more concerned about the number of patients that physicians need to send to the hospitals for care because they can no longer afford to treat them in their office. We are sending them to a system that is already stressed with inexperienced nurses, nursing shortages and the risk of hospital acquired infections.”
Donna Krueger, RN, OCN
Glen Morton Oncology Center
Chicago, Illinois

“I am the billing manager in a nine physician group treating 150 patients every day in each of 4 separate counties in Southern New Jersey, with over 800 patients currently in active chemotherapy treatment and follow-up. Almost half of our patient base is traditional Medicare with an additional 8% reimbursed at ASP+6% for drugs. This translates to over 57% of our total patient base being reimbursed at Medicare rates. Utilizing that fee schedule, 35 or more drugs in our inventory are currently reimbursed below our cost. There are an increasing number of our Medicare patients who are without secondary or medigap coverage. Conservatively, we would estimate that at least 10% of our patients fall into that category and that number continues to escalate. Further cuts would be crippling.”

Joyce Matola
The Center for Cancer and Hematologic Disease
Cherry Hill, New Jersey

“Particularly challenging in our group of 6 medical oncologists and 1 radiation oncologist are our 5 rural locations. Our radiation oncologist likely will not be able to stay in practice if the proposed cuts in 2010 are implemented. Closing this radiation facility would translate into a two hour drive, one way, for patients needing radiation therapy. Since radiation treatment runs consecutively for up to six weeks, cancer patients would be looking at 30 round trips with a 4 hour daily commute for life-saving care. Access issues, along with financial issues, are becoming the norm versus the exception in cancer clinics.”

CMS is in the process of reading over 11,000 comment letters on the 2010 Medicare Physician Fee Schedule and working on the final rule. We did not leave the meeting with any expectation that CMS would forestall the cuts. In fact, CMS related to us that these were not cuts but a “redistribution” of Medicare funds.

We heard loud and clear from congressional staff after the meeting that our practices need to be fully engaged in fighting these cuts. As a result, we are taking the following immediate actions:

Working with our state societies and practices in our states to generate letters to our entire congressional delegation, including all Representatives and Senators. Connecticut, Ohio, Kentucky, Oklahoma, Louisiana, Montana, and Wyoming already have sent letters signed by oncologists in the state. Templates for these letters are on the COA website.

This is just a few of the things that we are doing immediately. The COA lobbying team is working Capitol Hill and the White House; we need to reach out to our members of Congress to empower this effort.

It is very clear to us that if we don’t enlist the support of our elected officials, CMS will make these cuts. And, unfortunately, many other medical specialties are actually advocating for the payment cuts to oncology because they finance their own payment increases. Click here to read a letter that these organizations are getting their physicians to send to their Representatives and Senators. These medical specialties stand to gain a 6% payment increase.

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