“We feel like there will be cuts, and if that happens, there will be the danger that patient access to oncologists will suffer,” said Scott Parker, executive director of Marietta-based Northwest Georgia Oncology Centers. “There are fewer oncologists in training, as people are second-guessing going into health care as a whole. This has become extremely problematic, and it’s mainly because people are unsure of the changes the government continues to propose. Many practices have had to close their doors because they can no longer afford to stay open. It is important for people to become more aware of what’s happening, and to know the ramifications of some of these proposals so that more people can become more involved to stop them.”
The changes that Parker said created deep wounds in the practices began in 2003, when Congress passed the Medicare Modernization Act, which changed reimbursement of cancer care from paying practices the Average Wholesale Price set by drug manufacturers to the Average Sales Price. Susanne Johnson-Berns, NGOC purchasing manager and the COA Patient Advocacy Network Georgia Chapter president, said practices have to buy from a distributor rather than directly from manufacturers, so practices are reimbursed for the discounted prices distributors are charged, not the higher prices the practices pay the distributors.
Currently, practices are reimbursed by the ASP of Part B Medicare and Medicaid drugs plus 6 percent for labor costs, such as the pharmacological mixing of the drug and the in-office insertion of the drug. Parker said practices are already struggling to stay afloat with the current regulations, and if a current measure proposed as a debt-reduction solution by Congress and the White House to lower the health care employee reimbursement from 6 percent to 4 percent passes, it will become nearly impossible to provide care to everyone in need, and his staff would have to be cut.
Parker said NGOC is the state’s second-largest oncology practice, with 10 practices across northwest Georgia, but has already had to cut 33 percent of its staff since 2007 and has had to closed two offices — one in Blairsville and another in Towne Lake — because of decreasing Medicare and Medicaid reimbursements year after year.
And Parker said his practice is not unique, as private oncology practices across the nation that have been able to stay open have faced cuts to their services or have been forced to join more costly hospital practices.
According to the Community Oncology Alliance, community cancer clinics, such as the NGOC, treat 84 percent of Americans with cancer. Berns said 80 percent of the approximately 8,000 new patients a year that the centers serve are on Medicare or Medicaid.
According to the COA, as of March, hundreds of community oncology practices across the U.S. have been impacted by changes in reimbursement over the past 3½ years: 199 were closed, 369 were in financial difficulty and 315 practices merged with hospitals that offered the promise of financial stability and access to drug discounts.
But Parker said joining a hospital costs commercially insured patients on average 30 to 40 percent more than a private practice because of contracting regulations.
Because of higher insurance premiums and copays, a downturn in the economy and uncertainty about future health care costs, NGOC registered nurses Shamichael Traylor and Diana Hurst started the nonprofit Loving Arms Cancer Outreach in March. Their group provides cancer patients in need with funding for everything from food to gasoline and provides them with support groups, volunteers and information about changes in cancer care.
“When we had to cut our chaplain and counseling programs due to lower reimbursements, we saw a need there because people loved those services,” Hurst said. “So we got involved and are working to provide those services through Loving Arms instead. With cutbacks in Medicare and Medicaid up in the air, people are scared because many are already struggling simply to pay their copays.”
Two bills — HR 905 and SB 733 — have been proposed to remove the manufacturer-to-distributor discount used in the ASP calculation. Two Cobb residents have signed a letter written to Sens. Saxby Chambliss (R-Ga.) and Johnny Isakson (R-Ga.) in support of the bills as part of the Georgia Society of Clinical Oncology — Karen Beard of Powder Springs, director of GSCO, and Hillary Hahm, M.D., of Marietta, who is on the GSCO board of directors.
Follow Katy Ruth Camp on Twitter at twitter.com/KatyRuthC.