Cancer clinics are turning away thousands of Medicare patients. Blame the sequester.

[Redfairen]

Cancer clinics across the country have begun turning away thousands of Medicare patients, blaming the sequester budget cuts.

Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.

“If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year,” said Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates in New York. “The drugs we’re going to lose money on we’re not going to administer right now.”

After an emergency meeting Tuesday, Vacirca’s clinics decided that they would no longer see one-third of their 16,000 Medicare patients.

“A lot of us are in disbelief that this is happening,” he said. “It’s a choice between seeing these patients and staying in business.”

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/03/cancer-clinics-are-turning-away-thousands-of-medicare-patients-blame-the-sequester/?hpid=z2

[msongs]

1. one might reasonably ask why these "drugs" cost too much nt

[dkf]

2. If Medicare negotiated drug prices then maybe the doctors could keep treating patients.

How much are other countries paying for these drugs?

[demosincebirth]

29. Probably more than 50% less in other countries

[slipslidingaway]

35. Medicare being able to negotiate drug prices was taken off the table ...

in a backroom deal with Pharma by which Party ...

Fill in the blank

[dkf]

37. You forgot to add Max Baucus.

[Lasher]

3. How can this be, when Medicare spending is not included in the sequester?

Only discretionary spending is involved. Medicare is among the mandatory programs that are excluded from sequester cuts.

[Trillo]

6. "Sequestration cuts 2 percent from Medicare pay for docs"

http://www.bizjournals.com/seattle/news/2013/04/01/sequestration-cuts-2-percent-from.html
"Smaller, private practices with high volumes of Medicare patients are expected to feel the pinch of this cut the most, said Bob Perna, senior director of health care economics at the Washington State Medical Association."

[sendero]

10. Medicare is getting a 2% cut.

..... effective 4/1/2013. These cuts affect inpatient (hospital, including acute care, rehab, long term care and psychiatric care) outpatient (including APC and fee schedule payments) and physician payments as well.

I have to admit that it is hard to understand how a 2% cut can create this much dislocation though.

[Yo_Mama]

30. It's explained in the article

The cancer doctors have to pay money for the drugs up front. For Medicare patients, they are allowed 6% writeup on the drug. Their administration fees are very little.

Well, there is always some loss and wastage, and cutting their 6% margin by 2% is actually cutting their reimbursement more like 30%. But they still have overhead costs for these patients, so now they will have to either spend their own money to treat these patients, or stop treating them.

How long any particular clinic can continue really depends on how much of a bank loan they have to cover the interval between buying the drug and getting paid back by Medicare. Those loans cost money. If they are using their own money they can continue longer, and if they don't treat many Medicare patients they can continue a lot longer, even if they are losing money on those patients.

This is very sad, but remember that SGR was supposed to cut fees by not 2%, but by more than 27%. And when I tried to explain to DU'ers that this would result in denial of treatment to Medicare patients, the majority response was just to cuss out the doctors.

For what it's worth, future scheduled Medicare cuts aren't going to be sustainable for these clinics either. Some of the rural hospitals get special higher reimbursements, and they may be able to keep going with these treatments. But there isn't the capacity in urban hospitals to take over the clinic roles, and there isn't enough of a margin in Medicare to fund expansion in hospital treatment centers. And there have been proposals to cut some of the special provisions for rural hospitals.

[sendero]

43. Yes..

... I actually read the article after I made that post. Medicare is a strange beast in that some things are under-reimbursed (like perhaps these drugs) and some things over (anything that is sold on TV as "no cost to you&quot .

It wasn't long ago that I though the sequester would only last a month or two. Now, I'm not so sure. There doesn't seem to be an actual constituency in congress or the administration that wants to end it.

This is only one of several debacles that will ensue if they don't stop this idiocy and soon.

[Kingofalldems]

18. Oops. Missed on that one.

[dembotoz]

4. me thinks it is time to raise some hell

cancer victim sit in would be interesting bad press for clinic and the parties

[Soundman]

5. Here is an email that my wife received. It has info on responding to this issue.

Sorry if the email format didn't copy and paste well.

April 2, 2013


Dear Patients and Friends of The Zangmeister Cancer Center,

You may have heard about "sequestration," the automatic spending cuts to defense, education, healthcare and other programs that are the result of the failure of Congress to compromise on how to responsibly rein in spending. Unfortunately, sequestration will have a severe adverse impact on cancer care. That's because it will cut payments to providers – your physician – for chemotherapy and other critical cancer drugs, paying for most at below cost. If these cuts are allowed to stay in place it will force further cancer clinic closings and push cancer care into higher-cost settings for patients and taxpayers. In the past 2 years in Ohio, several practices have moved to higher cost settings raising the costs of cancer care in their communities.

The Administration should not include cancer drugs as part of the sequester cut, but has ignored current law that clearly defines payment for these drugs. Here are ways you can respond and help:





You can help by signing an official White House petition to stop the sequester cut to cancer drugs. Simply do the following:
Go to http://wh.gov/HDEm
Click on the "Set Up Account" button, which simply requires your name, email address and zip code to verify you are a real, unique person.
Wait a few minutes to get an email from the White House with a link to the petition to sign. This email may appear in your “Junk” folder. Click on the link in the email to sign.
It's that simple! When we get 100,000 signatures in 30 days, the White House has to respond to the petition.


You can also Join the Facebook Event Page and Invite Friends


Login to Facebook
Go to https://www.facebook.com/events/166195813535404/
Click the "Join" button
Click the "Invite Friends" button
Check each friend you wish to invite to sign the petition
Click the "Save" button




Share the Petition Link on Facebook

Login to Facebook
Go to https://www.facebook.com/CommunityOncologyAlliance/posts/282793745186339
Click the "Share" option
Choose to share "On your own timeline"
Write some introductory text, such as "Take action NOW to stop the sequestration cut to cancer care drugs! Sign this White House petition that calls on the president to get involved then share this link!"
Click the "Share Link" button




Please help by calling your two Senators and your one Congressman or
Congresswoman to tell them:


“Please help stop sequester cuts to cancer care. Please ask the White House and Medicare to not make sequester cuts to cancer drugs.”

Representative/Senator
Local Number
Washington Number
Joyce
Beatty
614-220-0003
202-225-4324
Steve
Stivers
614-771-4968
202-225‐2015
Pat
Tiberi
614-523-2555
202-225‐5355
Rob
Portman
614-469-6774
202-224-3353
Sherrod
Brown
216-522-7272
202-224-2315


This is an important petition as these additional cuts to cancer care providers mean that the most efficient, friendly, lowest-cost cancer treatment centers will be at risk of closing, a dangerous trend that is already happening. Please help us make certain that the Obama administration takes seriously the threat to cancer care and corrects the impact of the sequestration on cancer drugs.

Please forward this email to everyone you know and ask them to sign the petition.

Please Save Cancer Care by making this one email reach millions of people!

Thank you.

The Physicians and Staff of The Zangmeister Cancer Center




The Zangmeister Cancer Center
Our mailing address is:
The Zangmeister Center
3100 Plaza Properties Blvd
Columbus, OH 43219

Add us to your address book

Copyright (C) 2013 The Zangmeister Center All rights reserved.

Forward this email to a friend
Update your profile

[Hoyt]

7. Bet they won't show the clinic's financial statements.

Well see how the docs react to cuts in their pay with a significant reduction in patients if they run off all Medicare patients.

[Yo_Mama]

32. The docs will get a raise in net pay running off the Medicare patients

They have costs for patients that are not going to be met in many cases with the new reimbursement scheme, so that means that each patient they treat would cost them money.

The docs either own the clinics or get paid a portion of the profits. Malpractice insurance goes up by the number of patients. There is hardly a practice out there that wouldn't do better by eliminating 20% of their patients.

That's just an ugly fact of life. Here's a PBS story about the problem:
http://www.pbs.org/newshour/bb/health/jan-june13/medicare_03-04.html

And here's an article about a related problem - consolidation:
http://www.nytimes.com/2012/12/01/business/a-hospital-war-reflects-a-tightening-bind-for-doctors-nationwide.html?pagewanted=all&_r=0

[Hoyt]

39. If they have patients to replace them, but most don't.

I've seen docs make a decent living off mostly Medicaid, which pays a lot less than Medicare.

[shenmue]

8. I hate the sequester

The sooner the Republicans in Congress are out of office, the better. They are hurting people!

[KoKo]

9. It's just the "Obama Haters" doing this...nothing to see there..

Move Along....


Although, it's true that the Med/Tech Industry will use every trick in the book to defeat ...MEDICARE FOR ALL...so they use "Obamacare" as the Excuse.

Still doesn't EXCUSE the RW'ers...but, there are TRULY big problems with Obamacare as it is now.

Without Single Payer....these arguments will go on and on and on.

[1StrongBlackMan]

21. First ...

This has NOTHING to do with ObamaCare.

Secondly ... read the above letter (maybe I'm parsing it too closely, but ...)

If these cuts are allowed to stay in place it will force further cancer clinic closings and push cancer care into higher-cost settings for patients and taxpayers. In the past 2 years in Ohio, several practices have moved to higher cost settings raising the costs of cancer care in their communities.

Wouldn't a reduction in revenue (reimbursements) result in/encourage "moving to LOWER cost settings? And, if the several practices moved 2 years ago, how is that on the sequester?

[Yo_Mama]

31. Higher cost settings means into hospitals

Hospitals can often get a better deal for various reasons.

So the argument here is that if the clinics must close, not only will the 2% cuts not only save money, they will cost Medicare more money.

[1StrongBlackMan]

46. Oh ...

Okay.

[jazzimov]

26. I support a "single-payer" system such as

"Medicare for all" - but it won't pass. Not today.

Maybe tomorrow, which means "sometime in the future".

I can't wait decades until Medicare for all wins approval. Obamacare is flawed, and not as good as Medicare for all. BUT, it passed. It's a good interim solution to most of the issues until the rest of the country comes to it's senses and passes Medicare/Medicaid for all.

I'd rather see Medicaid for all rather than Medicare for all. But that's not feasible. But maybe in fifty years. Right now, Medicare for all is not feasible. Maybe in 20 years.

Right now, we have Obamacare. It's not perfect by any means, but it's better than what we had - and it's a step forward:

It's PROGRESS.

Hence, as a PROGRESSIVE I support PROGRESS rather than moving backward simply because it didn't meet some kind of litmus test that was arbitrarily set-up by people claiming to be "Liberals". I prefer to think for myself rather than follow some litmus test to be accepted by other "Liberals".

Thus, I support Obamacare because I see it as a means to an end - not as an end in itself.

[ProfessionalLeftist]

11. And the psychopathic, sophomoric Republicans think this is FUNNY?

They've been laughing and smirking since the sequester went into effect as if they are SO proud of themselves.

Really?

[HeiressofBickworth]

12. Ah, yes, it's working just as planned.

Those on Medicare (the "takers" to some) will die for lack of care while cancer care will continue to be available to those with money. That's why they don't want to get to the point of the business closing down. When no hospital, clinic, physician will take Medicare payments, the GOP can point to the general failure of the program and eliminate it completely. Congress is not concerned because THEY will never be denied care.

We may as well get used to it. We are considered a pustule on the ass of the wealthy that needs to be lanced and drained.

[forestpath]

14. +1

[indepat]

13. So our government has, in effect, created a plethora of death panels via the sequester and is about

to needlessly and willfully kill countless of the elderly, sick, and frail via the budget that's in the making. Truly the government of the people, by the people, and for the people, one that promotes the general welfare, has passed from existence, replaced by a corporatist government which promote the welfare of the uber-wealthy, large corporations, and oligarchs so evident in its works.



Edited to add to

[forestpath]

15. Exactly...and Obama wants to cut the Social Security benefits of the ones who make it through this!

[jazzimov]

24. No, he doesn't. Stop spreading disinformation, please.

I encourage information, not knee-jerk reactions.

[forestpath]

25. You are the one spreading disinformation. Unless you want to accuse

Bernie Sanders of being a liar.

President Obama visited Capitol Hill on Tuesday afternoon in an effort to get Senate Democrats on board with his sequester replacement plan, which contains some tough sells for the caucus—particularly on Chained CPI, a new and less generous way to calculate government benefits.

When Senate Democrats proposed their sequester replacement last month, it didn’t have Chained CPI, and many members have openly spoken out against it. Accordingly, Obama was repeatedly pressed on the issue—and appeared to hold firm in his position.

Senator Bernie Sanders described the exchange to The Nation on Tuesday afternoon. “The issue came up. The president raised his concerns about the long-term sustainability of programs like Social Security, and indicated that he believed something like Chained CPI is an effective way—what he considers to be [an effective way], to protect the program,” said Sanders.

On that, Obama got pushback from multiple senators. “Some of us suggested there are other ways to address the problem in terms of the long-term solvency of Social Security, such as doing what he proposed in 2008, which is to lift the cap of taxable income,” said Sanders.

http://www.thenation.com/blog/173314/senate-democrats-press-obama-chained-cpi#

[savebigbird]

16. Call me naive, but...

...since when is it acceptable that healing the sick is considered a business venture and doctors business people? Sorry, but I've never been ok with it.

I'm sorry to detract away from the horrors described in the OP, but this is an excellent example of why public services should not be privatized. Look at what privatization has done to the health of our country!

I'll step down from my soap box now.

[forestpath]

19. I agree with you. I used to work for a doctor and she felt the exact same way too.

[Yo_Mama]

33. Well, if the doctors can't stay in business without treating it as a business???

Don't they need to treat it as a business? Right now most places take losses on some of their patients. But the reason these clinics are freaking out is that they will not be able to STAY OPEN if they do not start cutting patients.

They don't want to do it. Their alternative is not to be able to treat patients at all.

So many seem to assume that doctors are making tons of money, but actually they aren't on many of their patients. The higher prices the private insurance patients pay subsidizes Medicare and Medicaid patients. When reimbursements are cut enough, the subsidy from the other patients fails to cover the clinic expenses.

[savebigbird]

42. I know these things.

I was really talking about the big picture - that our government, and in turn, our society and culture, and in turn, our government, etc. recognizes medical care as a business venture; and by privatizing other facets of public service, we'd be sending these fields on to similar paths.

[proverbialwisdom]

17. Lance Armstrong and LiveSTRONG will step up to organize the public, oh, wait. nt

What a disgrace.

[ProSense]

20. Republicans are celebrating.

The Morning Plum: The sequester is not a Beltway joke

Posted by Greg Sargent

It is now an established truth in Washington that the Obama administration committed a horrible strategic error in hyping the impact of the sequester: Its impact was overblown, and partly as a result, Republicans have “won” the political battle over it. The sequester is little more than fodder for jokes about White House tours.

It’s true that in a number of specific instances the White House did falsely inflate the consequences of sequestration. But what if, on the broad strokes, it is actually true that the sequester cuts are doing real damage all over the country — damage that is only just beginning?

The Huffington Post set out to document 100 news articles showing the sequester taking a toll on local economies and communities nationwide. It wasn’t hard to do. HuffPo summarizes the situation this way:

The grips of sequestration are just now beginning to be felt and the effects are already quite dramatic.

Organizations and companies have begun laying off workers, while many more have decided not to staff vacant positions. Schools on military bases are contemplating four-day weekly schedules. Food pantries have closed, as have centers that provide health services. Farmers have been forced to go without milk production information, causing alarm in the dairy industry and the potential of higher milk prices. Workers at missile-testing fields are facing job losses. Federal courts have closed on Fridays. Public Broadcasting transmitters have been shut down. Even luxury cruises are feeling the pinch, with passengers forced to wait hours before debarking because of delays at Customs and Immigration. Yes, sequestration is creating the possibility of another poop cruise.

Meanwhile, Buzzfeed documents the tale of a 39-year-old army reservist and combat veteran who saw his Ft. Meade desk job pay deeply slashed — and is now contemplating going back to war to improve his situation.

The Republican position on the sequester has been that these cuts are a victory for the party because Republicans wanted cuts all along. But at what point does this position become unsustainable? Even some Republican officials are beginning to complain about sequester cuts they don’t like — cuts to obscure programs most Americans have never heard of. At the same time, they have embraced the general goal of the Paul Ryan budget — which, if it were ever actually implemented, would wipe out huge swaths of just the sort of government programs Republican officials have now discovered they like, thanks to the sequester.

- more -

http://www.washingtonpost.com/blogs/plum-line/wp/2013/04/02/the-morning-plum-the-sequester-is-not-a-beltway-joke/

Boehner takes sequester victory lap
http://www.democraticunderground.com/10022583419

[Babel_17]

22. This blows my mind (nt)

[jazzimov]

23. WTF? Drug prices have absolutely NOTHING to do with

doctors. The doctor may prescribe the drug(s), but the doctors' payment has NOTHING to do with the costs of the drugs he/she prescribes.

I call shenanigans.

[Yo_Mama]

34. That's not true in these clinics

The clinics have to buy the drugs upfront, plus all the materials used to administer the drugs and treat the patients.

Cancer drugs are different than regular prescription drugs. You can't just go to a pharmacy and get them - these are infusion drugs that have to be administered in controlled conditions. They are not pills that you can just take. The pill types of cancer drugs are handled as you describe.

Medicare pays the clinics back for the average cost of the drugs plus 6%. Now that 6% is being cut to 4%. The prices of the drugs can fluctuate, so sometimes the clinics are paying more for some of these drugs than they are even getting paid back. They are very expensive.

Plus there are all the overhead costs of the cliniic. Assuming that the clinic never gets beat on price (they are always paying only the customary price), the total margin they use to cover treating these patients has just been cut by over 30%. Before this cut, that total margin wasn't always sufficient to cover the cost of the treatment. Now they will lose money over time.

[dkf]

36. Medicare should negotiate a bulk price and doctors are just the conduit

And service provider.

There. Problem solved.

[Yo_Mama]

38. I agree

We need to be more proactive. I think the costs overall could be brought down and it would save a lot of money.

So why don't we do this? Where there are real opportunities to cut costs it seems we don't examine them and go for them. I'm beginning to think that only the lobbyists run government. The patients can't negotiate prices and the doctors at these places can't negotiate prices. This is a classic public-good type of situation, which is what the government is supposed to be set up to do.

So where are the proposals to actually deal with some of our problems in a way that really doesn't have to hurt anyone? Instead we yammer on about stuff like chained CPI - everything's pretend right now, it seems.
'
I realize that very many problems we face don't have easy solutions, but some do. This is one. I get the feeling that our government just doesn't work well any more.

[dkf]

41. It is a head scratcher...

How very frustrating to realize things that make sense can't be done for who knows what reason.

[magic59]

27. Welcome to the world of for profit healthcare

Its a train wreck waiting to happen.

[quadrature]

28. I want to see the tax returns, of the places that...

claim they will go under.

keep in mind that most of these places are
S-Corps or limited-liability-companies
that are 'pass-thru' for income tax purposes.

[liberal_at_heart]

40. that is such crap. The reason health care is so expensive in this country is because doctors and

hospitals get to charge hundreds of times more than what it should cost even for something as simple as an aspirin. We must demand they bring their prices down.

[loudsue]

44. The real death panels: "we'd lose money". That about sums it up.

Some people are just not worth losing money over, I guess.

[Redfairen]

45. kick *

[Apophis]

47. So what I'm reading is that money is more important than saving people's lives.

Our country is going to hell.