Cancer Care Is Jeopardized by Medicare Reimbursement

Drug Benefit Trends, Drug Benefit Trends Vol 22 No 2, Volume 22, Issue 2

Changes to Medicare’s reimbursement plans have inadvertently cut payments to cancer specialists, causing many cancer care centers to lose money and possibly close, according to results of a study commissioned by the Community Oncology Alliance (COA), an advocacy group for oncologists who practice outside of large hospital centers.1

Changes to Medicare’s reimbursement plans have inadvertently cut payments to cancer specialists, causing many cancer care centers to lose money and possibly close, according to results of a study commissioned by the Community Oncology Alliance (COA), an advocacy group for oncologists who practice outside of large hospital centers.1

Medicare pays for only 56% of the expenses of delivering chemotherapy, according to study findings. Under the Medicare rules, this payment will be reduced to 45% in 2013, said Ted Okon, executive director of the COA. Okon also stated that the average practice in the United States was losing $500,000 a year, and in many cases, patients with private insurance are being charged more to make up the difference. What this means for many patients in rural areas is that their infusion center may close, forcing them to travel possibly several hundred miles to receive chemotherapy.

The American Cancer Society reports that cancer is diagnosed in 1.3 million Americans every year and, according to the COA, 85% of cancer patients receive treatment in a community oncology practice. The survey focused only on infusion services and was conducted by Avalere Health, a Washington, DC–based consulting group. Avalere acknowledges that the results may not be representative of community oncology centers that offer surgical or radiological treatment.

References:

Reference
1. Reuters. Medicare cuts damage cancer care, group finds. http://www.reuters.com/article/idUSTRE61328F20100204. Published February 4, 2010. Accessed February 16, 2010.