"I can attest with certainty that patients who struggle to make their copays while managing chronic, debilitating and life-threatening diseases require consistency in who is managing their disease condition and where," said Davenport-Ennis. "Reductions in Medicare reimbursement to physicians over the past several years have made it very difficult to maintain their practices in the critical community-based setting, where most patients receive their care. This cannot happen to our cancer delivery system."
Health officials throughout the cancer community attribute this growing trend to both the effects of the sequester and reduced reimbursement for Medicare Part B drugs. Effective April 1, the federal sequester reduced reimbursement for Medicare Part B cancer therapies from the current Medicare payment rate of the "average sales price" (ASP) plus 6 percent to just ASP plus 4.3 percent, resulting in severe financial losses for practices that treat cancer patients in the community. Even before this change, community-based cancer clinics maintained that drug reimbursement rates failed to adequately pay for the acquisition and related costs (such as storage, inventory, waste disposal, pharmacy and admixture facilities and staff) of life-sustaining cancer drugs.
The result, according to cancer community representatives, is that many critical cancer drugs are reimbursed below cost, and many are consolidating, merging with hospitals, or closing. The additional sequester-related cuts mean that unless cancer doctors personally fund a portion of each Medicare patient's treatments for drugs, patients must look elsewhere for care.
Some of the drugs cited by community-based cancer clinics as having Medicare reimbursement levels below the actual cost it takes to acquire and administer the drug include Taxotere, Taxol, Cytoxan, 5FU, Dextran-high, Iron Chelation, Iron Dextran, Adriamycin, Carbotaxol, Aredia and certain drug "cocktails" – or combinations.The impact of redirecting patients away from community-based clinics to hospital settings is shown to impact patients directly through higher copayments, longer travel times and increased travel expenses, visits to multiple providers and locations for care and services, and delays seeking treatment even as cancer progresses. All these factors result in disruption in the continuity of care, less streamlined care, increased chances for complications, and duplicative tests or procedures.