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Being Your Own Advocate

Patrick W. Cobb, MD
Published: Wednesday, Mar 09, 2011
I had never thought of myself as a political operative. I’ve been an oncologist in Billings, Montana, since 1995. When I was younger, there wasn’t much concern about getting reimbursed; you billed and you were paid. As far as my political involvement, it was nearly nonexistent. I never expected to walk the halls of Congress, meet with more than 50 members, and talk to my colleagues about the importance of traveling to Washington, DC, to make sure that our voices were heard. (I remember once bumping into Sen. Max Baucus [D-MT], now chairman of the Senate Finance Committee, in a cafeteria when he was running for re-election in 1996. I had to ask someone, “Isn’t that Senator Baucus?”)

However, as the current chairman of the Policy Committee and 2008-2010 past-president of the Community Oncology Alliance (COA), which represents more than 2500 oncologists at community cancer clinics, I am now an expert on the advocacy process, and I travel each month to the nation’s capital to advocate on behalf of oncologists and our cancer patients.

Why do I do this? Seven years ago, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which changed how doctors are reimbursed by the Centers for Medicare & Medicaid Services (CMS). When payments for chemotherapy administration were reduced, it forced oncologists to take on a new active role. We then established COA to mobilize the oncology community, including physicians, patients, administrators, nurses, and other healthcare providers, to increase awareness on Capitol Hill about how the law was affecting the cancer care delivery system. This has become an increasingly critical role now as oncologists are fighting for the lives of their patients and their practices—community cancer clinics, which treat 84% of Americans with cancer.

As the World Health Organization predicted, this year cancer overtook heart disease as the leading cause of death. About 7.6 million people died of cancer in 2008, and about 12.4 million new cases are diagnosed each year, according to a report by the American Cancer Society.1 The report further states that cancer costs more in productivity and loss of life than AIDS, malaria, the flu, and other diseases that are spread from person to person. Cancer’s economic toll was $895 billion in 2008, which is equivalent to 1.5% of the world’s gross domestic product.1

Although cancer is the number one killer of Americans under age 85, the good news is that cancer survival rates in the U.S. continue to improve. The e number of Americans living with cancer is likely to increase with the aging population, more screenings leading to earlier detection, and current treatments allowing patients to live longer. As a result, more oncologists will be needed in the future to administer the treatments to the growing population of patients. It is estimated that by 2020, the country will be 4800 oncologists short.2 Unfortunately, the state of physician reimbursement has disillusioned many practicing oncologists today about the Medicare system.

Physician reimbursement penalized

Congress has failed to address the Sustainable Growth Rate (SGR), the formula used to calculate payments to physicians annually based on the economy. The intended purpose of this formula was to place constraints on the growth of Medicare. However, it appears that physicians alone are being punished for the increases in Medicare spending, despite the fact that physician reimbursement is a very small part of overall spending. Congress has blocked the cuts each year, and, in December, the seven-month patch will end again.

For the past 6 years, the SGR has reduced Medicare reimbursement for some of the most expensive drugs and services used to care for cancer patients. The CMS Physician Fee Schedule for 2010 cuts even deeper, reducing payment for chemotherapy administration services an additional 5% annually, and up to 20% by 2013. There are additional cuts for cancer diagnostic imaging and physician consultation services. Medical practices cannot continue to provide care when they lose money.

Many community oncology clinics treat patients who cannot afford supplementary insurance and are solely dependent on Medicare. This alone causes financial pressure for oncologists who are already losing money from inadequate reimbursements for drugs and chemotherapy administration, as well as other overhead expenses.


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