Doctors take notice as cancer gets more costly
Bloomberg News
Gale Tickner doesn’t even know how much money she owes these days — it could be $100,000, it could be $200,000. With every surgery or unexpected complication, the medical bills for her cancer treatment keep piling up.
Tickner has health insurance, but the numerous copayments for her hospital visits, procedures and drugs over the past year and a half have made her treatment a financial burden.
“We’re just going to take it a day at a time to pay what we can, when we can,” she said.
The rising cost of care is a source of growing alarm — and not just for patients. It was the a subject of debate at the annual meeting of the American Society of Clinical Oncology in Chicago this weekend, where doctors are examining new ways to package cancer treatment to make it more affordable.
Cancer care has long been costly. There are signs that it is getting even more expensive for consumers, who are now required to shoulder a greater portion of medical bills in the form of insurance copays. The society has pointed to a National Institutes of Health study that estimates total treatment costs in the United States will rise 40% to $175 billion between 2010 and 2020.
Drug prices are part of the concern. Global spending on oncology medication is projected to rise 6% to 8% a year through 2018 to as much as $147 billion, the IMS Institute for Healthcare Informatics said in a report this month. That compares with a 6.5% rate over the past five years. The newest therapies in the market, which cost $100,000 to $150,000 a year before discounts, are being used in more and more types of cancer and tested in combination.
“People tend to think it’s a problem for the lower socioeconomic class, but traditionally those individuals have more resources available to them,” said Kim Bell, an administrator who helps patients with financial management at the Cleveland Clinic’s Taussig Cancer Institute. “But it’s really hard for the middle and uppermiddle class because there are not that many people who can afford that kind of thing out of pocket.”
The soaring costs are leading to changes at hospitals such as the Cleveland Clinic, which is adding staff specifically to help patients navigate their insurance policies and understand what their out-of-pocket expenses are going to look like from the start. A patient could face bills of as much as $50,000 a month.
Last week, the American Society of Clinical Oncology announced a proposal to have oncology practices paid for better managing patients’ care. They would get a $750 upfront payment for treatment planning, $200 a month during treatment, $50 a month for monitoring during breaks in active treatment and $100 a month for participation in clinical trials.
In return, they would be responsible for keeping patients from needing urgent hospitalization and for appropriately using services, while maintaining a high standard of care. The proposal is part of a U.S. government-led plan to come up with alternatives to the current system of paying a separate fee for each service that a doctor or hospital provides.
Tickner, 48, is in remission after battling a rare form of cancer that attacked her bone marrow, liver and spleen. Her home is in Florida, but the vast majority of her treatment was done in New York City, where she was able to secure housing at an American Cancer Society facility for out-of-state patients. To help manage and fight her bills, Tickner enlisted a service called OnPulse.
While the latest drugs are helping patients live longer, they also create a conundrum — more cancer patients needing further courses of treatment to sustain themselves. That is making it even more difficult for the health system to keep up with higher demand for cancer care.