Oncology NEWS Today Blog.

Support crumbles for community cancer clinics

By Greg Freiherr | August 9, 2010

There was a time when a cancer diagnosis meant long commutes for patients in small communities and rural America. The kind of care they needed was available only at tertiary medical centers, typically in metropolitan areas. An expanded network of community cancer clinics changed that, providing convenience and comfort for many thousands of patients. A few years ago those centers were treating four out of five U.S. cancer patients. But now this net of care providers is collapsing under the weight of falling Medicare reimbursement.

In the past three years, 166 community cancer clinics have closed in the U.S. and it is getting worse, according to the Community Oncology Alliance, which warns that the pace of closings has been increasing since January 2010. Since the beginning of this year alone, 39 community cancer clinics in 15 states have closed or are in the process of closing. If this trend continues, the number of shuttered clinics could double by the end of this year.

And this is only the most visible fallout. Cuts to Medicare reimbursement are causing administrators at remaining community cancer facilities reduce staff and services. Closures and cutbacks are forcing patients to seek treatment outside their communities. But many cannot travel the distances required to get treatment, according to oncologist David Eagle, MD, newly elected COA president. Underscoring the impact of these cuts is the fact that about half of all U.S. cancer patients are covered by Medicare.

Eagle estimates that Medicare cuts have affected more than 850 clinics in the U.S. This number includes facilities that have closed their doors; are struggling to pay bills; or have been acquired by hospitals or other entities. Rural practices and those with higher proportions of Medicare and Medicaid patients are particularly hard hit.

Medicare payment for the administration of chemotherapy has been cut by 35% since 2004, which is an effective cut of 47% when you factor in the increase in the Medical Economic Index. Medicare is scheduled to make additional payment cuts in each of the next three years. A study completed by Avalere Health shows that Medicare covers only 57% of the cost of providing this critical component of cancer care. Medicare is also cutting tests, such as PET and CT scans, typically used to evaluate cancer patients.

This could cause deeply seated problems that will plague healthcare in the U.S. for years to come. The National Analysts research and consulting firm reports that 20% of oncologists would discourage a medical student/resident from pursuing a career in oncology while only 3% would have done so in 2003, prior to the problems caused by year-over-year Medicare cuts. This will exacerbate an anticipated shortage likely to be caused by the retirement of currently practicing oncologists. By 2020, pundits estimate there will be a shortage of 4,080 oncologists.

“The government has to act now to stop Medicare cuts in order to preserve our nation’s cancer care delivery system before it’s too late,” said Ted Okon, COA executive director. “Unrealistic payment policies are pushing (our cancer care delivery system) off a cliff.”

by Lottie Duthu | December 19, 2010 1:02 AM EST

The statement by the pharmaceutical company that they will charge what the market will bear for cancer drugs is outrageous. I am aware of the high costs of cancer drugs, being a cancer patient myself and struggling with the ever rising costs over a period of years. Patients are having to mortgage their homes to pay their medical expenses. We have become an "insurance poor" country, when we have to pay exhorbitant sums for insurance coverage and threatened by the goverment that we will be fined if we don't purchase prescription coverage. I know some people who hit the donut hole in the first month. We need change, but I am yet to see any change for the better. If anyone is waiting for the government to take care of them, they have blinders over their eyes.

by world cooperation | December 17, 2010 12:43 PM EST

The Win-Win scientific initiative is a movement . It is not an organization. It is not in competition with any. It is based on collaboration and cooperation. As proposed by ICEDOC www.icedoc.org The initiative aims at enhancement of scientific approaches that could lead resource sparing and cost effective treatment in the world including High income countries, provided that the treatment outcome would be accepted scientifically in each country. No one would lose!. More cancer patients would have access to treatment and (contrary to belief) may the industrialists and pharmaceuticals companies would gain more flourished markets even for the newer drugs and tailored equipment technology.

To read an article representing the start of the proposal of the Win-Win scientific initiative :( Full free texts are available on line) :

- Elzawawy AM : Breast Cancer Systemic Therapy: The Need for More Economically Sustainable Scientific Strategies in the World. Breast Care 2008;3:434-438 (full text is available online in the website of Breast Care, Karger www.karger.com/brc) or browse: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ArtikelNr=170233&Ausgabe=243485&ProduktNr=231161

Ahmed Elzawawy, MD

Coordinator of the win-win scientific initiative

www.icedoc.org

by Barry Kaplan | December 02, 2010 5:23 PM EST

The comments above are full of half truths. The closure rate of oncology centers is proof positive that oncologists are not making vast profits from drugs or anything else. The profit margin at my group oncology practice is 7%. I don't know what you are going to gain by cutting more. Maybe some of the outrageous charges of the drug companies and the ridiculous overhead of the insurance companies can be targeted instead. Just as one example, Celgene charges $73,000/year for revlimid, a pill doctors make no money from and which cost Celgene almost nothing to develop. As the president of Celgene once said to the Wall Street Journal, "we will charge whatever the market will bear." The problem with cancer costs have far more to do with the cost of care in hospitals, the cost of radiotherapy and radiology procedures and the cost of the drugs we use rather than the medical oncologists who are rapidly being destroyed.

by Gregory Pawelski | December 02, 2010 11:18 AM EST

The shift in the US more than 20 years ago, from the institution-based, inpatient setting to community-based, ambulatory sites for treating the majority of the nation's cancer patients has prompted in large part additional costs to the government and Medicare beneficiaries. The Chemotherapy Concession gave oncologists the financial incentive to select certain forms of chemotherapy over others because they receive higher reimbursement.

The U.S. government wasn't reducing payment for cancer care under the new Medicare Modernization Act (MMA) of 2003. They were simply reducing overpayment for chemotherapy drugs, and paying cancer specialists the same as other physicians. The government can't afford to overpay for drugs, in an era where all these new drugs are being introduced, which are fantastically expensive. What needs to be done is to remove the profit incentive from the choice of drug treatments. Medical oncologists should be taken out of the retail pharmacy business and let them be doctors again.

by Robert Parsons | September 04, 2010 6:03 AM EDT

Amereica has to come to terms with cost effective treatments. The reimburst for treatment is linked to the cost of the drug. The more expensiive treatment your oncologist uses the more they get pain. This is insane and is a direct conflict of interest. Spend a little less on treatment and you could spend more on the service. A significant number of new treatment have little to no evidence of improved survival, this evidence can not be collected because trials are stopped by measuring other surrage marker such as time to progression or disease free survival. There is significant evidence to suggest these markers are not accurate. In America the Medico-industrial complex rules. Drug companies make fortunes and the oncologist are involved as they get greater wages too. The wages of oncologist in America have to be disassociated from drug cost. If that happends you may have more cost effective spending on drugs and be able to spend more on service provision.

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