Clifford A. Hudis, MD
Despite repeated attempts to pass a permanent fix to address Medicare’s sustainable growth rate (SGR) formula, efforts by lawmakers on both sides of the aisle have stalled again. So, it looks like another temporary patch will have to do.
The Senate passed the bill by a bipartisan 64 to 35 vote on March 31, which now heads to the president’s desk. The bill includes language to fix the SGR for 12 months and delay ICD-10
Industry stakeholders would have much preferred a permanent fix to the SGR formula, but most are in favor of a stopgap measure to prevent a 24% drop in Medicare reimbursement rates from going into effect on April 1.
The bill, HR 4302, calls for a 0.5% update through December 31, 2014, and a 0% update from January 1, 2015 through March 31, 2015. In addition, it includes a provision to delay the transition to ICD-10, which would prohibit the Department of Health and Human Services from implementing the transition at any point before October 1, 2015.
Landmark Report Released
This legislative drama is playing out even as the US cancer care system is faced with the prospect of a dramatic increase in the number of patients with cancer, and proportionately fewer oncology specialists to treat them, the American Society of Clinical Oncology (ASCO) warned in a webcast on March 11.
During the webcast, led by ASCO President Clifford A. Hudis, MD, the group called for Congress to help stabilize payments to doctors under Medicare by repealing the SGR. The webcast also highlighted a landmark report released by ASCO, The State of Cancer Care in America: 2014
.The State of Cancer Care in America: 2014
highlights how oncologists are trying to adapt to a growing demand for services, changes in healthcare delivery systems, and to the economic pressures that small oncology practices face. Specifically, the ASCO report addresses the challenges faced by a shrinking oncologist workforce, the viability of the small and mid-sized practices in rural areas of the country, and quality and value initiatives to implement moving forward.
Viability of Small and Mid-sized Practices
As a result of payment cuts and lowered reimbursement for chemotherapy agents, ASCO says smaller practices, which consist of 1 to 2 physicians, are becoming increasingly rare. As the primary source of cancer care in small towns and rural communities in the South and West, this trend will make access to local high-quality, personalized treatment burdensome to patients.
In 2013, the ASCO National Oncology Census noted shifts in the characteristics of oncology practices, notably changes in practice size, the number of affiliations between practices and other entities, and a wider array of physician specialties housed within each practice. The census was fielded in 2012.
The census data suggest that oncology practices as a whole are growing larger and that smaller practices (consisting of 1 to 2 physicians) are becoming increasingly rare (see Figure 1
What’s fueling the decline in the number of small and mid-sized practices are recent cuts to Medicare physician payments and other factors. These practices, concentrated in the South and West, serve more than one-third of new patients, according to ASCO’s research.
ASCO is concerned because these smaller practices are often the primary providers of cancer care, enabling people to receive high-quality, personalized treatment that’s close to home.
Figure 1. Size of Practice as a Proportion of Total Respondents
Source: American Society of Clinical Oncology. The State of Cancer Care in America: 2014. Reprinted with permission
Carolyn B. Hendricks, MD, a solo practice medical oncologist in suburban Maryland said during the ASCO webcast that, for the first time, she couldn’t afford to treat her patients in her office but had to send them to the hospital to receive their infusion therapy. “My patients were very surprised to see the out-of-pocket costs associated with receiving treatment in a hospital,” she said during the webcast.
Her practice faces a daunting future because of the increased cost of chemotherapy drugs and the lowered reimbursement paid by the Centers for Medicare & Medicaid Services, a practice sometimes referred to as “buy-and-bill.”
“Giving chemotherapy is expensive,” she said. “My practice has lost revenue and has to purchase chemotherapy on credit and then scramble to be reimbursed adequately.”