Lawmakers put costs ahead of patients in Medicare overhaul
The Senate Finance Committee just advanced a sweeping Medicare overhaul. Unfortunately, the bill does little to help America’s sickest patients; it jeopardizes physicians’ ability to provide timely, quality care to tens of millions of Americans. Congress would be wise to reject it.
The proposal in question impacts Medicare “Part B,” which covers doctor’s visits, outpatient procedures like same-day surgeries, and most medicines administrated by injection or IV drip. Currently, roughly 50 million seniors and 10 million Americans with disabilities benefit from Part B.
Under the current system, physicians and hospitals purchase Part B drugs directly and then bill Medicare for reimbursement. In addition to the drug’s cost, Medicare gives providers a small financial markup — 4.3% of the average domestic sales price of a drug — to cover overhead costs. This includes specialized storage and patient monitoring after a drug is administered.
The Senate Finance Committee bill fundamentally alters the reimbursement process — and not for the better.
Right now, Medicare doesn’t consider manufacturer discounts to physicians — known as “co-pay coupons” — when calculating provider reimbursement rates. This allows doctors and hospitals to receive more compensation for administering Part B treatments, thus encouraging them to participate in the program.
But the Senate Finance Committee bill would allow Medicare to factor these discounts into its reimbursement system. And once Medicare formally acknowledges that doctors pay less for Part B treatments, they will receive less reimbursement money.
In other words, the change would function as a de facto reimbursement cut to providers and hospitals that help treat patients with lots of advanced medicines.
Reimbursement cuts would have grave consequences for both physicians and patients. Many practices and clinics already have razor-thin margins. Cutting reimbursements further would push some operations to the edge of insolvency, forcing them to turn away patients or close their doors entirely.
During previous Medicare reimbursement cuts in 2013, for instance, approximately 80% of oncologists said the cuts affected their ability to deliver quality care. Fifty percent reported sending patients
Reimbursement cuts would have grave consequences for both physicians and patients. Many practices and clinics already have razorthin margins.
elsewhere for treatment.
Cancer patients can’t afford any more setbacks. According to the Community Oncology Alliance, more than 420 community oncology practices closed their doors last year. An additional 350 reported they were struggling to stay afloat. Any more cuts to hospital and doctor reimbursements would certainly hinder physicians’ ability to care for patients.
It’s not just cancer patients; the change would harm Americans struggling with a host of complex conditions ranging from arthritis, to immunodeficiencies, to blood disorders and more. These patients shouldn’t need to worry whether they can find a doctor willing to treat them on top of their chronic health ailments.
More than 100 patient advocacy organizations just sent a letter to the Senate Finance Committee opposing these drastic changes to Medicare Part B for this very reason. As the letter reads, “policies the committee is considering put program costs before the health of patients living with serious illness.”
Their analysis is spot on. Congress — and those lawmakers sitting on the Senate Finance Committee in particular — should toss this idea. Cutting reimbursement rates impedes patient access to lifesaving treatments.
The author is president of the Oncology Managers of Florida, a professional organization committed to providing information and governmental support to oncology practice managers in Florida.