Proposed reimbursement changes for cancer patients distressing to oncologists

[Hopeful]

http://www.oncologystat.com/news-and...eting__US.html

http://www.oncologystat.com/news-and...unami__US.html

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[Rich66]

Please copy and post the text.

[Joe]

Community Oncologists Paint Grim Picture at Town Hall Meeting

Elsevier Global Medical News. 2009 Feb 9, C Helwick


SCOTTSDALE, Ariz. (EGMN) - The national economic crisis has added fuel to a fire already stoked by diminishing reimbursements, continued hassles with third-party payers, and the financial burden of serving the underinsured. Oncologists are at the tipping - maybe even the breaking - point, they said at a town hall meeting held during the Community Oncology Conference.
"Frankly, I heard more dismay than I expected," Dr. Lee Schwartzberg, conference chair and a senior partner at the West Clinic in Memphis, said in an interview.
"The system is clearly at the breaking point and the current economic crisis is accelerating that breakdown," said Dr. Schwartzberg, editor in chief of the journal Community Oncology. "Fissures are starting to form, and the big quake is coming that will swallow health care whole for many of our cancer patients."
Fear that patients are now receiving suboptimal care because of matters beyond their control was echoed by the community oncologists. The sense of urgency stems from the rising percentage of patients who can no longer afford copayments on drugs, especially when expensive biologics are prescribed. The National Health Interview Survey released last week showed that 2 million cancer survivors are foregoing necessary medical care because of cost concerns.
"Copays of 20% are not reasonable any more for my Medicare patients," said Dr. Patrick Cobb of Billings, Mont.
Recent job layoffs are spiking these numbers, and oncology practices are facing some tough choices: Refer patients to hospital infusion centers, treat the patients pro bono, spend more time finding patient assistance programs, or have difficult conversations up front.
Glenn Balasky, executive director of the Zangmeister [Cancer] Center in Columbus, Ohio - where even the main hospital just laid off 300 workers - said, "We sit down with every patient before we treat them, look over their insurance, tell them how much money they will have to pay us prior to treatment, and let them know that if they slip we will be having another conversation. We set expectations up front, rather than making cost an ugly issue later. We never had to do this before."
Dr. Gary Gross, of Tyler, Tex., predicted that in lieu of dollars he may soon start accepting "gifts of chickens and fresh eggs, like they did in the 1930s."
Sarah Green, R.N., of Olympic Hematology Oncology in Olympia, Wash., added, "We try to insulate our physicians from the details of how we make treatment happen for these patients, how we find the cheapest out-of-pocket approach. And for all the effort we put into this, we get no revenue back. I have two full-time employees in the billing office spending all their time on patient assistance programs."
When patient assistance programs cannot solve the problem, oncologists have been relying on hospital infusion centers, but some attendees reported their hospitals are beginning to refuse these patients as well. According to Dr. Schwartzberg, in 2009 hospitals must file for reimbursement for chemotherapy infusions under a new system that is no longer economically favorable to them.
For some practices, one cost-savings solution is to close satellite clinics. In rural areas, this creates a real hardship for patients, according to Dr. Cobb. "We had to close our site in Sheridan, which had been open for over 6 years. These patients now have to travel 2 hours to Billings," he said.
Some think the worst is yet to come. Mr. Balasky predicted, "The flood will come 6-12 months from now, when we will see fundamental changes in employer-based insurance programs that further affect our insured patients."
While most oncologists are hoping for change with the new administration and Congress, some are calling it quits. Mariana Lamb, executive director of the 350-member Medical Oncology Association of Southern California, reported, "Physicians are retiring 10 years before standard retirement age. Instead of treating patients, they are now dealing art and managing commercial properties for a living. The government can bail out an antiquated auto industry, but not us, the people who treat cancer. It's disheartening."

Joe

[Hopeful]

Cancer Care Braces for a Tsunami

Elsevier Global Medical News. 2009 Feb 10, C Helwick


SCOTTSDALE, Ariz. (EGMN) - Powerful forces are building that could radically alter the payment system for the delivery of cancer care.

At the annual Community Oncology Conference, Ted Okon, executive director of the Community Oncology Alliance in Washington, described the potential changes as a "tsunami" involving "catastrophic shifts."
Cancer care is in the spotlight of health care reform because of the sheer number of cancer patients and survivors, the aging population, and the steep increase in costs associated with modern drugs, Mr. Okon said. "The result could be a fundamental and potentially devastating impact on the cancer care delivery system, which is already under strain.

"Community oncology practices are already adversely impacted by Medicare cuts to drug and service payments. They are swamped by the government quest to pay for quality versus quantity. This is where the health care system must go, and it sounds great on paper, but it could be one giant cost-cutting exercise," said Mr. Okon.

"This is not all bad news," he added. "It's a call to action for community oncologists to step up and be proactive, unified, and vocal, and to produce data to help shape payment reform."

According to Mr. Okon, the payment landscape could be reshaped by a number of potential changes:
-Determination of therapy by the Centers for Medicare and Medicaid Services (CMS) with treatment dictated by CMS' payment leverage.
-Reform of the physician payment system, which is currently based on the sustainable growth rate (SGR).
-Resurrection of the competitive acquisition program (CAP).
-Pursuit of the primary care medical home concept.
-Institution of value-based purchasing.
-Institution of service bundling and episodes of care.
-Development of comparative effectiveness systems.

Together, these could spell big changes for community oncologists, he said. The definition of "medically necessary" may change and become the purview of the CMS. Medical specialties that provide more expensive care likely will experience a decrease in payment for services, and the following of quality standards and measures currently is evolving from a means to a bonus to a future requirement and on to a penalty those who do not comply.

The renewal of CAP could create a radical change to the current "practice-based, just-in-time drug" distribution system. Finally, adoption of the medical home model could result in increased payments to primary care doctors coupled with cuts in specialty care payments, he predicted.

Of all the forces, value-based purchasing and services bundling could create the most fundamental shifts in reimbursements to community oncology practices, Mr. Okon said.

Physicians would be moved from a per-service payment system to one based on outcomes, with the "risk element" placed squarely on the practices. And while comparative effectiveness could be a good thing, it has the potential of allowing government to "trump" oncologists' decision making and to focus more on cost than on quality, he said.

This is the second of the two articles linked. Thanks, Joe, for taking care of the first one.

Hopeful