Medicare is cutting critical cancer care funding -- it's time for Congress to step in

[Judi Lynn]

BY MARCUS NEUBAUER, OPINION CONTRIBUTOR - 11/29/22 7:30 PM ET

Over the past decade, hospital-driven acquisition of independent physician practices nationwide has been well-documented. According to one report, the pandemic accelerated this trend, with hospitals gobbling up over 3,200 physician practices in 2019 and 2020 alone, resulting in an 8 percent jump in the number of hospital-owned practices. This underscores the pressure independent physicians are facing as they navigate rising administrative and financial burdens.

Consolidation raises out-of-pocket costs for patients and increases costs to the overall health care system with no evidence of increased quality or efficiency. Policymakers say they want to lower health care costs, yet the Centers for Medicare & Medicaid Services (CMS) is once again pursuing policies that will exacerbate consolidation pressures.

Community cancer clinics offer tremendous value to patients, as they provide access to high quality care in the most cost-efficient setting, close to patients’ homes and support systems. Unfortunately, Medicare’s Physician Fee Schedule (PFS) Final Rule for 2023 is the latest in a wave of payment cuts that threaten to critically destabilize Americans’ community cancer practices. Physicians, including community oncologists, are currently facing an alarming 4.5 percent cut during one of the most economically turbulent times in recent history.

Oncology has one of the highest rates of consolidation, largely driven by payment disparities across different sites of service. This means that Medicare pays different rates for the exact same patient for the exact same service depending on whether the service is provided in the physician office setting or in the hospital outpatient setting, which is often more expensive. For example — because patient cost sharing is based on a percent of the total charge — a patient may pay twice as much for cancer treatment if they receive care in the hospital outpatient department instead of a physician’s office.

More:
https://thehill.com/opinion/congress-blog/3755457-medicare-is-cutting-critical-cancer-care-funding-its-time-for-congress-to-step-in/

[summer_in_TX]

1. Recently I had an endoscopy in what had been

a physician-owned facility now owned by Christus Santa Rosa.

I asked the nurse, who'd worked in that facility more than 20 years, how the change had been.

She said the transition had been trying, but she understood why so many practices were being bought by big outfits like Christus: they couldn't get insurance companies to reimburse them adequately for care as smaller and independent groups. But the big healthcare outfits like Christus could.

I wonder what role if any that has had in Medicare's reaction.