| Veteran 2005-09-23, 4:32 pm |
| Cancer patients pay in fight
Doctors, Medicare duel over chemo.
South Florida Sun-Sentinel
Published Wednesday, February 2, 2005
FORT LAUDERDALE, Fla. - Cancer patients on Medicare are caught in the
middle of a fight between doctors and the government, and as a result
they might be forced to pay more for chemotherapy and cancer drugs,
patient advocates said.
As of Jan. 1, Medicare cut reimbursements to doctors for buying drugs
they inject into cancer patients, and so far a few doctors have
responded by making patients buy their own drugs, advocates said.
Medicare will not reimburse patients for the cost. It pays only for
drugs given by hospitals or physicians.
In addition, doctors say the cuts might prompt some oncologists to stop
giving intravenous chemotherapy in their offices, instead sending
patients to less personal cancer centers in hospitals.
"It's going to be devastating if all this comes to pass," said Beth
Guendjoian, a Boca Raton, Fla., retiree who gets weekly chemotherapy
from her doctor for breast cancer that spread into her bones.
Congress had directed Medicare to lower payments for intravenous cancer
drugs after studies showed the government has overpaid doctors -
sometimes wildly - for years. Medicare never intended for doctors to
make big profits from supplying medications.
Oncologists paying an average of $22 for a dose of the common chemo
drug paclitaxel, or Taxol, used for many cancers, were being reimbursed
$138, a federal audit said. This year, Medicare will drop its payment
to $26.72. Doctors were collecting $17.52 for a dose of vitamin booster
leucovorin that cost $1.11. They now will be paid $1.24.
The new rules cut $468 million, or 11 percent, from the $4.3 billion
Medicare spent last year on cancer drugs, said a December report by the
U.S. General Accounting Office. The report estimated that doctors would
still make 6 percent profit on drugs.
To help ease the hit, Medicare has boosted reimbursements to
oncologists for administering chemo by $392 million, or 130 percent,
after conceding that it has underpaid for those services.
"What we're trying to do is get these payments right - the right
amount for administration of the drugs and the right amount for the
drugs themselves," Medicare spokesman Gary Karr said. "We don't think
it will hurt anyone."
Oncologists, however, said because of the cuts, they will lose money on
some drugs. Many have used the excess drug payments to subsidize parts
of their practices that lost money, such as supplies and care for the
uninsured.
"We barely can pay the overhead with this new formula," said Marvin
Diaz-Lacayo, an Aventura, Fla., oncologist, who otherwise agrees that
Medicare needs to economize. "If I lose money, I'll close my infusion
center and send patients to the hospital."
Hospital chemo units tend to be less personal than physician offices,
where the staff is more familiar with patients' needs and history,
oncologists said.
"Taking patients out of their doctors' offices and sending them
through a McDonald's-like chemotherapy service, it's going to have
an effect," said Dax Kurbegov, an oncologist at Holy Cross Hospital in
Fort Lauderdale. "You develop very intimate relationships with your
patients. There's as much psycho-social support as anything else
going on, and that's important."
Guendjoian, the Boca Raton cancer patient, said getting chemo at a
hospital could take hours longer than it does now.
"Somebody's going to be paid for it anyway. What's the purpose of
the inconvenience for a patient who is sick?" she said.
The Medicare Rights Center, a national consumer group, has fielded
complaints from a small but growing number of patients who say their
doctors refused to continue buying chemo drugs. The patients had to buy
them but do not expect to be reimbursed by Medicare, center officials
said. A chemo treatment program with Proleukin, for example, would cost
almost $12,000.
"Desperately ill Americans are caught in a murderous web between their
doctors and Medicare," said Robert Hayes, president of the center.
"It's cruel, it's unacceptable, and it must be fixed immediately."
The center has asked Medicare to either force the doctors to continue
buying the IV drugs or to start reimbursing patients who buy them.
Medicare and medical groups said they need another month or two to
assess how deeply the new rules will affect doctors and patients in the
real world. The American Society of Clinical Oncology is surveying
doctors for Medicare, which has said it would consider raising payments
for a drug if doctors lose money on it.
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