TODAY'S PAPER
32° Good Afternoon
32° Good Afternoon
NewsHealth

Cancer clinics turning away Medicare patients

Cancer clinics on Long Island and across the country have begun turning away thousands of Medicare patients and blaming the sequester budget cuts.

Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.

Patients at these clinics would need to seek treatment elsewhere, but the only real alternatives are hospitals, which generally offer more expensive care and which may not be equipped to handle the influx.

"If we treated the patients receiving the most expensive drugs, we'd be out of business in six months to a year," said Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates, which has clinics in Setauket, Patchogue, Smithtown and Brightwaters. "The drugs we're going to lose money on, we're not going to administer right now."

After an emergency meeting Tuesday, Vacirca's clinics decided they would no longer see one-third of their 16,000 Medicare patients.

The impact of the sequester on cancer treatment has only recently become clear, adding an unintended consequence to a budget process that was already controversial for its blind, across-the-board cuts.

Legislators meant to partially shield Medicare from the sequester, limiting the program to a 2 percent reduction -- a fraction of the cuts seen by other federal programs. But oncologists say the cut is damaging for cancer patients because of the way those treatments are covered.

A note to our community:

As a public service, this article is available for all. Newsday readers support our strong local journalism by subscribing.  Please show you value this important work by becoming a subscriber now.

SUBSCRIBE

Cancel anytime

Medications for seniors are usually covered under the optional Medicare Part D, which includes large private insurers that are absorbing the cuts. But because cancer drugs must be administered by a physician, they are among a handful of medications paid for by Part B, which covers doctor visits.

The federal government typically pays oncologists in community clinics for the average sales price of a chemotherapy drug, plus 6 percent to cover the cost of storing and administering it. Since oncologists cannot change the drug prices, they argue that the entire 2 percent cut will have to come out of that overhead allowance.

"If you get cut on the service side, you can either absorb it or make do with fewer nurses," said Ted Okon, director of the Community Oncology Alliance, which advocates for hundreds of cancer clinics nationwide. "This is a drug that we're purchasing. The costs don't change and you can't do without it. There isn't really wiggle room."

Medical Oncology and Blood Disorders, a Connecticut clinic, sent patients a letter last month stating that if the sequester cuts went into effect, "We will not be able to treat our Medicare patients effective April 2013."

Cancer patients turned away from local oncology clinics may seek care at hospitals, which also deliver chemotherapy treatments.

The care will likely be more expensive: A study from actuarial firm Milliman found that chemotherapy delivered in a hospital setting costs the federal government an average of $6,500 more annually compared with a community clinic, and out-of-pocket costs to Medicare patients are $650 higher.

Some cancer clinics are counting on the federal government to provide relief, and are continuing to see patients even though they expect to lose money.

"We're hoping that something will change, as legislators see the impact of this," said Ralph Boccia, director of the Center for Cancer and Blood Disorders in Bethesda, Md. "I don't think we could keep going, without a change, for more than a couple of months."

A note to our community:

As a public service, this article is available for all. Newsday readers support our strong local journalism by subscribing.  Please show you value this important work by becoming a subscriber now.

SUBSCRIBE

Cancel anytime

Health