Medicare is slicing vital most cancers care funding — it’s time for Congress to step in

Over the previous decade, hospital-driven acquisition of unbiased doctor practices nationwide has been well-documented. In accordance with one report, the pandemic accelerated this pattern, with hospitals gobbling up over 3,200 doctor practices in 2019 and 2020 alone, leading to an 8 p.c bounce within the variety of hospital-owned practices. This underscores the strain unbiased physicians are going through as they navigate rising administrative and monetary burdens.

Consolidation raises out-of-pocket prices for sufferers and will increase prices to the general well being care system with no proof of elevated high quality or effectivity. Policymakers say they wish to decrease well being care prices, but the Facilities for Medicare & Medicaid Companies (CMS) is as soon as once more pursuing insurance policies that may exacerbate consolidation pressures.

Neighborhood most cancers clinics provide large worth to sufferers, as they supply entry to top quality care in probably the most cost-efficient setting, near sufferers’ properties and help programs. Sadly, Medicare’s Doctor Price Schedule (PFS) Last Rule for 2023 is the newest in a wave of fee cuts that threaten to critically destabilize People’ group most cancers practices. Physicians, together with group oncologists, are presently going through an alarming 4.5 p.c lower throughout one of the crucial economically turbulent instances in latest historical past.

Oncology has one of many highest charges of consolidation, largely pushed by fee disparities throughout totally different websites of service. Which means Medicare pays totally different charges for the very same affected person for the very same service relying on whether or not the service is supplied within the doctor workplace setting or within the hospital outpatient setting, which is commonly dearer. For instance — as a result of affected person price sharing relies on a p.c of the entire cost — a affected person might pay twice as a lot for most cancers remedy in the event that they obtain care within the hospital outpatient division as an alternative of a doctor’s workplace.

This fee disparity additionally creates a monetary incentive for hospitals to amass group oncology practices. In accordance with the nonpartisan Medicare Cost Advisory Fee (MedPAC), “fee variations throughout settings encourage preparations amongst suppliers—such because the consolidation of doctor practices with hospitals—that lead to care being billed on the fee charges of the supplier with the best charges, growing program and beneficiary spending with out significant adjustments in affected person care.”

And but, Medicare is slashing reimbursement to group oncologists on the similar time it’s growing reimbursement to hospital outpatient departments. Whereas doctor practices are set to see a major lower as a result of -4.5 p.c cuts talked about above, hospital outpatient departments are set to see a +3.8% improve from CMS in 2023. These cuts make no sense, neither from a fiscal or logical standpoint. Except addressed by Congress earlier than the tip of this 12 months, these cuts can be devastating to unbiased practices and predictably lead to additional hospital-driven consolidation.

Happily, Reps. Ami Bera, MD (D-Calif.) and Larry Bucshon, MD (R-Ind.) have launched bipartisan laws, which might go a great distance towards stabilizing struggling practices and safeguarding most cancers sufferers’ entry to excessive worth care. By blocking a lot of those cuts from coming into impact on Jan. 1, the Supporting Medicare Suppliers Act of 2022 (H.R. 8800) would lengthen a vital lifeline to physicians, together with the group oncologists that hundreds of People depend on for high quality most cancers care.

Congressional motion has averted catastrophe earlier than; lawmakers’ management is desperately wanted once more this 12 months. It’s not too late for Congress to guard entry to group most cancers care. I urge Congress to rapidly go the Supporting Medicare Suppliers Act of 2022 in order that America’s group most cancers care suppliers can proceed offering modern, life-saving care to America’s most cancers sufferers.

Marcus Neubauer, MD, is the chief medical officer of The US Oncology Community.