ASCO Presses for Payment Fix, Details Pressures on System

Clifford A. Hudis, MD

The US cancer care system is faced with increasing cuts to Medicare payments, the prospect of a dramatic increase in the number of patients with cancer, and proportionately fewer oncology specialists to treat them, the American Society of Clinical Oncology (ASCO) warned Tuesday.

In a webcast led by ASCO President Clifford A. Hudis, MD, the group is calling for Congress to help stabilize payments to doctors under Medicare by repealing the much-maligned sustainable growth rate (SGR), even as a March 31 deadline for action approaches. The webcast also highlighted a landmark report released by ASCO, The State of Cancer Care in America: 2014.

ASCO and other physician groups have been pressing Congress for years to alter the SGR. The US House of Representatives plans to vote on a replacement formula for reimbursing physicians for Medicare services later this week.

As a result of payment cuts and lowered reimbursement for chemotherapy agents, ASCO says smaller practices, which consist of 1 to 2 physicians, are becoming increasingly rare. As the primary source of cancer care in small towns and rural communities in the South and West, this trend will make access to local high-quality, personalized treatment burdensome to patients.

Carolyn B. Hendricks, MD, a solo practice medical oncologist in suburban Maryland said that for the first time she couldn’t afford to treat her patients in her office but had to send them to the hospital to receive their infusion therapy. “My patients were very surprised to see the out-of-pocket costs associated with receiving treatment in a hospital,” she said during the webcast.

Her practice faces a daunting future because of the increased cost of chemotherapy drugs and the lowered reimbursement paid by the Centers for Medicare & Medicaid Services, a practice sometimes referred to as “buy-and-bill.”

“Giving chemotherapy is expensive,” she said. “My practice has lost revenue and has to purchase chemotherapy on credit and then scramble to be reimbursed adequately.”

Years ago, the buy-and-bill model was lucrative. That’s quickly changing as higher priced drugs and lower reimbursement affect the viability of small practices, leaving them with four possibilities: purchasing another practice, selling the current practice, merging with a larger practice or hospital, or closing the practice entirely.

If more small practices close, it will have an effect on workforce shortages, says the report. ASCO estimates that by 2025, the demand for oncology services will grow by 42% or more, while the supply of oncologists will grow by only 28%. That translates to a shortage of more than 1480 oncologists by 2025.

Like most clinical care workforces, medical oncologists are growing older as a group. In 2008, the proportion of oncologists aged 64 years and older surpassed the proportion under 40 years of age, according to the report. That age gap is expected to grow wider, the report said, since medical oncologists tend to be slightly older than the general physician population.

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Such pressures on the oncology workforce could not come at worse time, however. Although advances in treatment and screening have produced a decline in cancer deaths in recent decadeswith 13.7 million survivors in the United Statesthe number of newly diagnosed cases of cancer is projected to increase by as much as 42% by 2025.

Responding to these challenges, ASCO is recommending the development and testing of new care delivery models and payment models, ending persistent financial threats, and repeal of the SGR. The group also recommends greater use of physician-led quality initiatives such as ASCO’s Quality Oncology Practice Initiatives (QOPI) and the CancerLinQ learning system that is currently under development and will provide oncologists, regardless of geographic location, personalized guidance and real-time quality feedback to improve patient care.

“The US cancer system is among the best in the world, but it cannot continue to meet the growing needs of patients unless fundamental, systematic change is pursued,” Hudis said. “We encourage Congress to seize this opportunity, and act now.”