Support crumbles for community cancer clinics

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.”