The US Oncology Network Applauds Introduction of Medicare Patient Access to Treatment Act

WASHINGTON, June 25, 2015 /PRNewswire-USNewswire/ -- The US Oncology Network – one of the nation's largest networks of integrated, community-based oncology practices dedicated to advancing high-quality, evidence-based cancer care – today commended Representatives Mike Pompeo (R-KS) and Don Beyer (D-VA) for introducing the Medicare Patient Access to Treatment Act (H.R. 2895), legislation to level the playing field by creating a more adequate reimbursement structure for cancer care delivered in the community setting.

"The Medicare Patient Access to Treatment Act is pro-patient public policy that would help to increase patient access to high-quality cancer care in the community-based setting and lower cancer care costs for both patients and taxpayers," said Dr. Michael Seiden, Chief Medical Officer, The US Oncology Network.  "We commend Congressmen Pompeo and Beyer for their leadership on this legislation and look forward to working with them and their colleagues in Congress to advance this valuable Medicare policy."

The Medicare Patient Access to Treatment Act will equalize payments for oncology care across sites of services where payment differences between community-based oncology clinics and hospital outpatient departments (HOPD) have contributed to a significant shift of cancer care delivery from physician-run community cancer clinics to the more expensive hospital outpatient setting. 

According to 2011 Milliman study, it costs Medicare $6,500 more per patient when care is delivered in the HOPD setting under current Medicare payment policy. Hospital outpatient chemotherapy spending is approximately 25 to 47 percent higher per beneficiary than physician clinic chemotherapy spending.

According to The Moran Company, 87 percent of cancer care was provided in community cancer clinics less than a decade ago, however recent data show that has changed dramatically in recent years. By 2011, the percentage of care in community clinics had dropped to 67 percent, with additional data showing an accelerated shift to the hospital setting in 2012 through 2013 due to a 20 percent increase in the rate of oncology clinic closings and hospital acquisitions. 

A 2014 report published in the Journal of the American Medical Association found that total spending per patient was 10.3 percent higher for hospital-owned settings compared with physician-owned settings. Expenditures were even higher in large health systems where per-patient spending was 19.8 percent higher than independent physician group spending.

Higher payment rates for healthcare services result in higher out-of-pocket patient costs in the form of both increased fees and copayments. For example, cancer patients receiving care in hospital outpatient settings are charged on average 10 to 50 percent more than they would be for the same service provided in a community-based setting, resulting in $650 more on average in patient out-of-pocket costs annually.

Neutralizing payments for outpatient services is a policy concept broadly supported by bipartisan lawmakers, Medicare experts and seniors advocates alike. The Medicare Payment Advisory Commission (MedPAC) has cited the large disparities in reimbursement as causing consolidation, closures, and hospitals purchasing more physician offices, which drives up Medicare expenditures.  AARP has also advocated for equalizing Medicare payments for physician services between hospital outpatient and office settings.

"Equalizing payments across all care settings would reduce healthcare spending, eliminate unfair incentives for consolidation, and protect patient access to healthcare in the community setting," added Seiden.  "We encourage lawmakers to support this legislation, which would create a fair and rational payment structure for the delivery of cancer care services."

SOURCE The US Oncology Network