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CO at a Glance
We Work for Health Colorado is a coalition of patient advocates, economic development organizations, bioscience companies, trade associations, labor unions and higher education institutions working together to educate our elected leaders, the news media and the communities they serve about the important contributions the biopharmaceutical industry and its employees make to the health and economic security of the State of Colorado.
Put yourself in the shoes of a cancer patient in rural Colorado. If she’s lucky, she has a cancer clinic somewhat close to home with an oncologist she knows well (and who knows her well). Less lucky are the patients who make an arduous trip across the state, often driving hundreds of miles round trip on a weekly basis. Thanks to an ill-considered Medicare Part B experiment proposed by the Centers for Medicare and Medicaid Services (CMS), those long drives to get life-saving treatments could likely become the norm.
Putting budgets and bean-counting ahead of the needs of older patients, federal bureaucrats have proposed cutting the reimbursements to providers for Medicare Part B. As many seniors know firsthand, Medicare Part B is one of the most successful programs in our nation’s history, providing medically necessary treatments and supplies.
Not surprisingly, chemotherapy and other cancer treatments are a major focus of the Medicare Part B program.
Older patients often tell us that they prefer the smaller, more personal setting of independent community cancer clinics for treatment rather than going to an outpatient hospital setting. But for more than a decade, Washington bureaucrats have been squeezing Medicare reimbursements and the results have been clear. In 2004, 84 percent of chemotherapy treatments were administered in physicians’ offices or treatment centers. By 2014, that number had dropped to 54 percent, with hospitals picking up the difference. This is, of course, before the effect of the proposed Medicare Part B cuts. And so the trend toward hospital chemotherapy treatment would greatly accelerate.
It is also worth noting that with the significantly higher overhead costs at a hospital versus a doctor’s office or a community cancer clinic, it is more expensive to Medicare for patients to be treated at hospitals. So the major concern that Washington has — rising costs — is actually made worse by their own rules.
Why are these proposed rules so problematic for rural treatment centers?
According to the Community Oncology Alliance, the new Medicare Part B rules will cause practices to lose money on nearly 50 of the more commonly used cancer drugs. That is just one example of how the cuts would be felt. Expecting a business to lose money on a core service and just carry on doesn’t match reality.
The challenge is that rural clinics are more difficult to staff and operate on a far smaller volume of patients than clinics in suburban areas. And they are much smaller than the outpatient facilities at hospitals. This is the attraction of community treatment centers for patients, but also their great challenge, since many of the rural clinics today operate at either a break-even or small loss.
Sadly, you can track the drop in Medicare reimbursements by the number of rural clinics that close. The proposed Medicare changes will be no exception.
The trend away from smaller, community-based cancer treatment practices is growing. According to the American Society of Clinical Oncology, the percentage of oncology practices with one to five doctors dropped from 64 percent in 2014 to 41 percent in 2015. That’s a massive drop in just 12 months, and our concern is that the proposed changes will cause that number to fall very rapidly. Today, I can count the number of independent community cancer clinics in Colorado on one hand.
This is the reality that rural cancer patients face. In our case, we have a patient who drives to our Littleton facility for treatment from Rifle on a regular basis. A 400 mile roundtrip is a tough ride for anybody, but particularly arduous for someone suffering the effects of cancer, and the chemotherapy required to treat it.
Bureaucrats in Washington don’t often have to face the consequences of the rules they draw up in large buildings back east. But by threatening the future of cancer care for rural Americans, whether intended or not, this Medicare experiment would have dire consequences indeed. CMS should listen to the countless patients, physicians and bipartisan Members of Congress who all agree the Medicare Part B cuts equates to bad medicine and should fully withdraw the proposal.
April Christensen is the executive director for the Coalition of Hematology and Oncology Practices (www.choptx.org) and lives in Northern Colorado.
AstraZeneca plc’s Boulder biotech manufacturing plant will get busy in coming weeks as the pharmaceutical giant brings in dozens of construction workers and begins readying the site to produce a cancer drug.
In October, as many as 300 construction contractors will be making changes at the Boulder plant that AstraZeneca bought a year ago.
The proposed Part B Drug Payment Model is also a value-based model, and it contains very little discussion of patients and patient choice. This is a problem, because ultimately any proposal that seeks to maximize health care quality must be patient-centered. Instead, this proposal could lead to patients losing access to infusions they depend on to function in daily life, even if it has taken that patient years to find a medication that works
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The Colorado Gerontological Society has been the leading resource, social service and advocacy organization for Colorado’s seniors since 1980.Learn More