Cancer cuts are too deep

Published by Baltimore Sun
Dr. Denise Gooch
August 27, 2015

The Centers for Medicare and Medicaid Services recently unveiled proposed changes to their payment approach for cancer care services delivered to American seniors. Hidden within the complicated language and updated payment codes lies a harsh reality for community-based oncology centers and, more importantly, the patients we serve.

Today, freestanding radiation oncology centers, like Greenbelt Radiation Oncology, serve more than 40 percent of all cancer patients and offer more convenient and personalized care than hospital outpatient facilities. Despite this fact, the proposed physician fee schedule for 2016 would cut payments to freestanding radiation facilities by 6 percent next year. This is on top of cuts to freestanding centers that have totaled nearly 20 percent over the last decade.

As the medical director of Greenbelt Radiation Oncology, I am concerned for the hardworking oncologists and staff members who have dedicated their lives to combating cancer. But when reviewing the policies laid out in the proposed fee schedule regulation, I am even more concerned for the highest risk patients we serve.

If the proposed changes were adopted, the payments for a course of care for prostate and breast cancer will be 36 percent and 32 percent less, respectively, than the same care provided in the hospital setting. This unjustifiable payment disparity will undoubtedly accelerate closure of freestanding centers and movement of patients to the hospital setting. According to a recent survey by The American Society for Radiation Oncology, 30 percent of freestanding practices indicated that they might now have to close their doors due to the cuts in the fee schedule.

For those diagnosed with prostate and breast cancer, these cuts will be disproportionately painful. The rate of prostate cancer in Maryland is 10.3 percent higher than the national average for all U.S. males and the rate of female breast cancer is 8.4 percent higher than the national average for all U.S. females, according to National Cancer Institute data.

More concerning is the higher rates in which both prostate and breast cancers affect minority populations. The American Cancer Society predicts about one in five African American men will be diagnosed with prostate cancer in their lifetime and mortality rates for prostate cancer are 2.4 times higher in African American men. African American women make up 33 percent of all new breast cancer cases but have significantly poorer rates of survival than women from other racial and ethnic groups, according to a report from the Susan G. Komen Foundation.

These figures are higher and much more alarming among African Americans across Maryland. National Cancer Institute data also show the rate of prostate cancer among black males in Maryland is 59.4 percent higher than the rates of prostate cancer diagnoses in white males.

Even more startling, the death rate resulting from prostate cancer is twice as high among African Americans than all races statewide. For breast cancers, the death rate resulting from female breast cancer is 42.3 percent higher among African American females than all races statewide.

Limiting access to cancer care for all patients, particularly African Americans, through policies that threaten community-based cancer care will only exacerbate the health challenges and patient health concerns felt across Maryland.

The closure of freestanding centers is not just a question of convenience it is a question of outcomes. For years, freestanding radiation therapy facilities have played a fundamental role in bolstering access to high-quality cancer care among traditionally underserved minority populations and, in turn, elevating health outcomes. Peer reviewed research shows that limited access to radiation oncology is associated with increased rates of prostate cancer mortality. Peer reviewed data also show longer travel times to an oncologist are associated with lower rates of breast conserving therapies. By cutting reimbursement rates to freestanding oncology centers, the government is threatening critical cancer care services.

Throughout my career in oncology care, I have witnessed incredible change. On one hand, science and technology are progressing at an astonishing rate. Treatments are more effective than ever, and survival rates continue to increase. But cancer still takes the lives of an estimated 600,000 Americans each year. Until that number falls to zero, our nation must take every step possible to protect cancer patients battling for their lives each day. This begins with protecting access to critical care delivered in freestanding oncology facilities not cutting off a lifeline to Americans living with cancer.

Dr. Denise Gooch is medical director of Greenbelt Radiation Oncology.

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