[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