National Patient Advocate Foundation Delivers Letter Urging Congress to Oppose Cuts to Cancer Care in Medicare Physician Reimbursement

Sep 23, 2010, 10:52 ET from National Patient Advocate Foundation

Data Shows That 172 Medical Practices Serving Cancer Patients Have Closed Due to Inadequate Medicare Reimbursement

WASHINGTON, Sept. 23 /PRNewswire-USNewswire/ -- The National Patient Advocate Foundation (NPAF), a national, non-profit organization dedicated to the mission of creating avenues of improved patient access to health care through public policy reform at the state and federal levels, delivered a letter to Members of the House and Senate last week urging Congress to oppose recently proposed oncology-specific cuts to Medicare physician reimbursement. The advocacy activities of NPAF are informed and influenced by the experience of patients who receive case management services from Patient Advocate Foundation (PAF), which provides professional case management services to patients with chronic, debilitating or life-threatening conditions.

Patient Advocate Foundation has had the opportunity to work with many providers' offices when dealing with unique patient issues and recently had the opportunity to learn how practices are impacted by decreased reimbursement.  One small oncology practice in Virginia, for example, reported it had sent patients elsewhere for treatment due directly to decreased reimbursement.  In addition, the practice explained it was referring many Medicare and Medicaid patients to local hospitals for outpatient treatment, as neither Medicare nor Medicaid reimbursed well or expeditiously.

According to data compiled by the Community Oncology Alliance and reported in Community Oncology in August 2010, 172 medical practices serving cancer patients have closed over the last three years in response to continuing Medicare reimbursement difficulties. PAF has also received information that states with closures include Alabama, Colorado, Connecticut, Florida, Georgia, Massachusetts, Maryland, Mississippi, North Carolina, New Jersey, New Mexico, Nevada, New York, South Carolina, Texas, Utah, Virginia, West Virginia and Wyoming.  Practices have reported struggling financially, being sold to hospitals, other practices or corporations and referring all chemotherapy and drug administration to the hospital setting or other site of care due to reimbursement, financial risk and patient out-of-pocket exposure.  In particular, small oncology practices are losing money on the most commonly used drugs for cancer care and are increasingly referring patients to hospital settings for care.

"Congress needs to assure that physicians are adequately compensated for providing cancer care to Medicare patients," said Nancy Davenport-Ennis, CEO & Founder, NPAF.  "Otherwise, increasing numbers of Medicare beneficiaries will be unable to access care as more physicians decline to accept Medicare patients.  This problem will be most acute in underserved rural areas and urban counties."

In 2005, NPAF commissioned a Geographic Access to Care study as part of its Global Access Project.  This study was published by researchers at the University of North Carolina and summarized the distribution of cancer patients and cancer care providers across regions and population types, paying special attention to potential differences in access to care that might be related to rural location, race, ethnicity or low-income status.  The study, which can be found at, found that "Forty-five percent of all rural counties in the study states have no oncology service providers at all – neither a hospital nor a hematology or medical oncologist… Nearly one-fourth of the urban counties also have no cancer care providers... Eighteen percent of rural counties have hospitals that report providing oncology services, yet there are no oncology physicians located within the county according to the CMS files."

"Proposed cuts to cancer care only compound the existing problem of inadequate Medicare physician reimbursement and elevate the concern of the patients we serve about continued access to oncology services," added Davenport-Ennis, noting that almost seventy-seven percent of patients contacting PAF for assistance have a cancer diagnosis.  "We urge Congress to assure that physicians are adequately compensated for providing cancer care to Medicare patients, so that patients are ensured continued access to the life-saving care they need."

In 2009, PAF resolved 55,384 patient cases and received more than 4 million inquires from patients nationally from all 50 states. The total of closed cases since 1996 is more than 400,000.  Eighteen percent of the patients served last year by PAF were Medicare patients.  These patients have mounting concerns that they could be at risk of not having a physician as evidenced by their outreach to PAF case managers serving this population.

National Patient Advocate Foundation (NPAF) is a national, non-profit organization that is dedicated to the mission of creating avenues of patient access through improved access to, and reimbursement for, evolving therapies, therapeutic agents, and devices through policy and legislative reform at the state and federal levels. Our mission is shaped by the experiences of the patients served through our companion organization, Patient Advocate Foundation.

SOURCE National Patient Advocate Foundation