06.27.05

Cantwell Urges President Bush Not to Leave Cancer Clinics in the Lurch

Cancer care for Medicare patients facing $400 million shortfall next year

WASHINGTON , D.C. – Sen. Maria Cantwell (D-Wash.) today urged President Bush to address a looming funding shortfall for cancer clinics caused by the Medicare prescription drug bill that passed Congress in October 2003. Citing a recent report that oncologists may lose $13 billion in Medicare reimbursements by 2013 because of the legislation, Cantwell joined a bipartisan group of 35 senators in sending a letter to Bush, urging quick action.

Congress cut funding for oncology clinics in order to pay for the prescription drug benefit contained in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 . Unfortunately, the ill-advised cuts went even deeper than expected, and when the full impact is felt starting in January of 2006, Medicare will reimburse oncologists far less than before the bill's passage, leading to inevitable reductions in patient care.

"The American people are paying billions for a Medicare prescription drug benefit that leaves millions of our seniors behind," Cantwell said. "Now we are just six months away from a disaster for cancer patients. The President needs to act quickly to avert this crisis."

Prior to the passage of the Medicare bill, oncologists were not fairly reimbursed for patient visits, but were able to compensate for those losses because of a higher reimbursement rate for providing chemotherapy and other cancer treatments. In order to pay for the costs associated with prescription drug coverage, Congress reduced payments for cancer treatment, but failed to permanently correct the unfair reimbursement rate for patient visits.

While the Center for Medicaid and Medicare Services (CMS) instituted a temporary fix this year to help oncology clinics survive the shortfall, it expires at the end of 2005. Without that funding, Cantwell and the other senators fear that community cancer centers will need to reduce staff and services, delivering a serious blow to patient care.

The letter, sent today, urged President Bush to extend the CMS temporary fix for another year, and work with oncologists to establish a long-term solution to the reimbursement mess. Without a solution, funding for cancer care is estimated to be reduced by $13 billion through 2013, according to an April report by PricewaterhouseCoopers. That includes $400 million in 2006 alone.

"We must guarantee that the cancer care delivery system in this country is strengthened for years to come," the senators wrote to Bush. "Our shared goal should be to work together to ensure that all Americans have access to high-quality, affordable, and accessible cancer care."

Cantwell opposed the Medicare prescription drug bill because it left behind too many of Washington state's seniors, included expensive giveaways to special interest "Pharmacy Benefit Managers," and shortchanged cancer patients and their health care professionals. In the wake of the bill's passage, Cantwell held nearly twenty hall meetings across the state, talking to Washingtonians about the Medicare prescription drug bill.

The text of the letter follows below:

President Bush

The White House

1600 Pennsylvania Avenue, NW

Washington, DC 20502

Dear Mr. President:

We have made great progress against cancer with earlier diagnoses, targeted therapy, and widely accessible cancer care delivered in community cancer clinics. As with all health care services, the challenge is paying for treatment advances. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) reformed reimbursement for cancer treatment by eliminating the overpayment for drugs covered under Medicare Part B. However, we are concerned that these cost saving measures may impair the ability of cancer clinics to treat patients in 2006.

Medicare is now paying for cancer drugs based on Average Selling Price (ASP) and, under the authority of the MMA, the Centers for Medicare and Medicaid Services (CMS) increased payments for chemotherapy administration services. The MMA also increased the Medicare payment rates for drug administration services provided by community cancer clinics, in part by creating a transitional fee increase for 2004, which decreased substantially in 2005 and is eliminated in 2006. These increased payments accounted for specific medical services that are not explicitly paid for under the new system but were implicitly paid under the old system as part of the drug overpayment. For example, the payment of cancer patient treatment planning is covered by Medicare for radiation oncology but not medical oncology. Additionally, cancer clinics are not being reimbursed for their pharmacy costs of storage, inventory, waste disposal, and adherence to increasing regulations for staff and patient safety.

On January 1, 2005, CMS implemented a demonstration project to provide reimbursement to physicians that survey cancer patients on their cancer and chemotherapy symptoms. This project retained an estimated $300 million in Medicare funding for cancer care. The demonstration project and transitional fee increase will expire on December 31, 2005 which will significantly reduce Medicare funding for cancer care by an estimated $400 million for 2006. Compounding this situation further is that private insurers are announcing cancer care payment reductions on December 31, 2005, modeled after Medicare. In an April 27, 2005, report by PricewaterhouseCoopers the Medicare funding reduction for cancer care is estimated to be $13.0 billion through 2013, $8.8 billion more than the $4.2 billion contained in the MMA.

We call upon your leadership to address this important situation. We ask that CMS work with the cancer community in correcting these problems and extend the $300 million demonstration project through December 2006. We must guarantee that the cancer care delivery system in this country is strengthened for years to come. Our shared goal should be to work together to ensure that all Americans have access to high-quality, affordable, and accessible cancer care.

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