Sequestration is set to hit Doctors, not necessarily patients
As a Medicare patient and a cancer survivor, I think the media hype over the sequester cuts for cancer chemotherapy drugs is causing false hysteria. First of all, the cuts are 2% across the board for all Medicare charges so the drugs are at market price plus 4% instead of 6%, that’s not that much for an oncologist with his own free-standing clinic.
Second, the smaller “for profit” private clinics are the ones getting hit hard by these cuts. What the media isn’t telling you is that these cuts first and foremost cut into the clinics profits, not the ability to treat patients All the more reason doctors are threatening to tell patients to go elsewhere.
Free standing chemo clinics are dangerous in the first place. Having worked in health care for 17 years, the amount of fraud and inefficiency I saw in private medical facilities compared to full blown hospitals was astounding. Hospitals have provider credentialing which is strict and safer than free-standing clinics. They can also buy these drugs in bulk lowering the cost of the drugs needed.
Cancer patient Debbie Curl went to a freestanding clinic where the oncologist was definitely for profit. They harassed her for co-pays, threatened to refuse treatment, and radiated her hip until it was permanently broken.
She finally went to the John Wayne Cancer Center at Santa Monica Hospital where she got much better treatment. Because of the cancer registry, her progress and decline was tracked and in addition it helps with research grants. Incidentally, the oncologist she left lost his license due to misconduct.
Another patient, Mary Riedel went to Kaiser Permanente in California where they do not have free-standing clinics at all. She went to Kaiser for all her treatments and paid the standard co-pay. When she had exhausted all brand name chemo drugs on the market, Kaiser prepared an experimental study where Mary could try a new drug as a guinea pig. She lived a year longer as a result. Mary had to drive 50 miles one way for her cancer treatment because her insurance was Medicare administered through Kaiser.
If somebody has a bad reaction to a new drug, they have to be transported to a local (or non-local) emergency room anyway. In Mary Riedel’s case, she was already at a proper hospital and went into anaphylactic shock twice. If proper nurses weren’t present, they would not have been able to give her epinephrine in time and she could have died right there.
Medicare pays (or did pay) 6% above the average retail price of a particular drug. When you look at the mark up from the drug company to the doctor or hospital, it pales in comparison to the mark up when they are billed to the patient or insurance company.
Physicians take a Hippocratic Oath, a 2% decrease will not force doctors get rid of their mansion, yacht and Mercedes. By the way, we can thank President Bush for his unpaid part D prescription drug program for this. Now these drugs are falling under Medicare Part B and that is what the sequester cut. Medicare providers and patients need to keep this in mind.
Aren’t doctors supposed to be in the business of healing people, not making 25% operating profits (this includes salaries, overhead, etc.) for profit or non-profit medical companies? We all need to stop questioning who is going to pay the health bills and start asking why they are so high.
Chemotherapy drugs can cost up to $18,000 per treatment (just for the drugs) and up to $48,000 with administrative costs. Oncologists are complaining all their patients have to travel thousands of miles for treatment. In truth, they are speaking specifically about clinical trials. Oncologists care more about their pockets than their patients. Some cancer patients enrolled in clinical trials in rural areas will have to travel thousands of miles to continue their treatments as a by-product of spending cuts brought on by the sequester. Clinical trials are usually free of cost.
Congress is trying to reform bill HR 1416 and has sent a letter to Medicare (CMS), we are hoping for an answer soon. Hopefully, the outcry coming from the 24 hour news networks will end if Congress can collaborate with Medicare (CMS) who made the decision to remedy the situation, not Congress. Either way, I expect these changes are forthcoming with health care reform in general.