Tuesday, Aug. 26, 2003 | 9:27 a.m.
Editor's note: In August the Where I Stand column is written by guest writers. Today's columnist, Dr. Ed Kingsley, is an oncologist and president of the Clark County Medical Society.
DON'T LET these lazy dog days of summer lull anyone into a false sense that nothing significant has been happening in Washington, D.C., during the so-called August recess of Congress. As we Southern Nevadans have tried to cool off in our pools or temporarily leave this desert for cooler climes, some members of Congress and their staff have been hammering out details of the single most massive revision of Medicare since the program's inception almost four decades ago.
Two Medicare prescription bills, already passed independently by both the U.S. Senate and the House of Representatives earlier this year, are now in conference committee where legislators from both chambers hope to reconcile their differences and craft a final bill -- the Medicare Prescription Drug and Modernization Act of 2003 -- that President Bush, who supports a Medicare prescription bill, will sign.
Although the prescription medication payment provision for Medicare recipients has been getting the most attention by the media and public, this 1,500-page legislation actually encompasses much more than just that. For example, it addresses the physician shortage in rural areas, nurse practitioners working in hospices, chiropractic, family therapist and mental health counselor services and hospital emergency room functions, among other things.
This bill is probably going to cost us, the taxpayers, billions of dollars. And where is this money going to come from? Here's part of the answer: Hidden inside this behemoth bill is a provision that deeply slashes chemotherapy reimbursement to oncologists, the doctors who administer those drugs to cancer patients.
This clause has been added to divert funds from cancer care for our seniors to help pay for the prescription part of the bill. In other words, our elected representatives are robbing Peter to pay Paul. And the Medicare cancer patient could be on the losing end of the stick.
There are some in Congress who believe that the oncologists have been overpaid through excessive chemotherapy drug reimbursement. Unfortunately, this bill totally ignores the fact that oncologists have, for many years, been underpaid for the costs of administering these drugs. Therefore, they have had to rely on any profit made from chemotherapy drugs to cover their expenses to administer those same drugs.
A clinical practice expert panel was recently convened to look at direct costs of chemotherapy administration codes. The clinical practice expert panel data estimated that approximately 80 percent of chemotherapy administration costs are not reimbursed by Medicare.
On the basis of this analysis, the Health Care Finance Administration (now the Centers for Medicare and Medicaid Services, the body that governs Medicare) commissioned the American Society of Clinical Oncology to confirm these data. That American Society of Clinical Oncology study has been completed and in fact confirms the clinical practice expert panel data.
Therefore, if this plundering of funds currently designated for chemotherapy drugs, as contained in this legislation, is not balanced by an equitable increase in reimbursement for chemotherapy administration, then this legislation could severely cripple if not eviscerate the world's best cancer care system, almost all of which is currently administered very efficiently in out-patient community cancer centers through out the country. It could force these clinics to stop treating Medicare cancer patients altogether who would then be forced to seek their treatment elsewhere, including already overcrowded hospitals which would be ill-equipped to manage such a massive onslaught of this type of patient care.
If Congress feels compelled to tinker with the way chemotherapy reimbursement is currently being done, it must then also balance that with a significant increase in the reimbursement for chemotherapy administration -- it's simple economics.
If there is to be any reform of our cancer care in this country than it must be balanced. Otherwise, our current, highly effective and world-respected cancer care system could seriously founder, forcing the more then one million Medicare cancer patients to go looking elsewhere for their next chemotherapy treatment.
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