Death by a thousand cuts: cancer clinics turning patients away due to sequester

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    Apr 04, 2013 2:43 PM GMT
    And what's more, these patients have to go to hospitals to get their chemo, and hospitals get paid more to administer them. Penny wise, pound foolish.
    http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/03/cancer-clinics-are-turning-away-thousands-of-medicare-patients-blame-the-sequester/Cancer clinics across the country have begun turning away thousands of Medicare patients, blaming the sequester budget cuts.

    Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.

    Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.

    “If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year,” said Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates in New York. “The drugs we’re going to lose money on we’re not going to administer right now.”

    After an emergency meeting Tuesday, Vacirca’s clinics decided that they would no longer see one-third of their 16,000 Medicare patients.
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    Apr 04, 2013 3:13 PM GMT
    q1w2e3 saidAnd what's more, these patients have to go to hospitals to get their chemo, and hospitals get paid more to administer them. Penny wise, pound foolish.
    http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/03/cancer-clinics-are-turning-away-thousands-of-medicare-patients-blame-the-sequester/Cancer clinics across the country have begun turning away thousands of Medicare patients, blaming the sequester budget cuts.

    Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.

    Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.

    “If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year,” said Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates in New York. “The drugs we’re going to lose money on we’re not going to administer right now.”

    After an emergency meeting Tuesday, Vacirca’s clinics decided that they would no longer see one-third of their 16,000 Medicare patients.


    Who do you suppose made the political decisions for allocating the 2% cuts to Medicare? Do you believe that Medicare is so efficient that they weren't able to find room for reduction other than highly visible ones deliberately designed to harm Americans for public support?

    You should be angry - Americans should be angry that the lives of cancer patients would be used in this way as political fodder.
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    Apr 04, 2013 3:26 PM GMT
    The 2% Medicare cuts aren't specifically targeted to chemo patients. Cuts are made in all fields, including mine. Dialysis treatment pyaments are being cut as well starting April 1st.

    If such treatments are so important, then money's got to be available to pay for them. Revenue isn't enough, therefore, increase revenue. There's no simpler logic than that which Congress is not able to grasp.

    The fact that some of these cuts are made more visible does not help others which are less visible and don't have proponents as influential. Yes, you can reverse a specific cut like education grants for military, but the other 999 cuts still hurt.
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    Apr 04, 2013 3:29 PM GMT
    q1w2e3 saidThe 2% Medicare cuts aren't specifically targeted to chemo patients. Cuts are made in all fields, including mine. Dialysis treatment pyaments are being cut as well starting April 1st.

    If such treatments are so important, then money's got to be available to pay for them. Revenue isn't enough, therefore, increase revenue. There's no simpler logic than that which Congress is not able to grasp.

    The fact that some of these cuts are made more visible does not help others which are less visible and don't have proponents as influential. Yes, you can reverse a specific cut like education grants for military, but the other 999 cuts still hurt.


    Again you didn't answer the question. Do you think that Medicare is so efficient that it couldn't afford a 2% cut? Let's not forget that sequestration was something orchestrated by the Obama Administration.

    Instead the people you defend have specifically designed the cuts in places that are most visible and harm people the most. How craven and disgusting.
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    Apr 04, 2013 3:37 PM GMT

    http://www.huffingtonpost.com/2013/04/02/sequestration-effects_n_2996101.htmlThe Huffington Post set out to do an extensive review of sequestration stories from the past week, with the goal of finding 100. What seemed like a daunting task was completed in hours. No one region of the country has been immune. Rural towns in Alaska, missile test sites in the Marshall Islands, military bases in Virginia, university towns across the country, and housing agencies in inner cities are all beginning to feel the cuts.


    You keep blaming the White House. Remember it's 98% what Boehner wanted and signed onto, and the generic Republican in the House still has not acknowledged how bad sequestration is, except when it hits home.

    http://www.huffingtonpost.com/2013/04/04/sequestration-2013_n_3010065.html?utm_hp_ref=politics

    So it sounds like you don't want Medicare cuts. Good for you.
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    Apr 04, 2013 3:39 PM GMT
    q1w2e3 said
    http://www.huffingtonpost.com/2013/04/02/sequestration-effects_n_2996101.htmlThe Huffington Post set out to do an extensive review of sequestration stories from the past week, with the goal of finding 100. What seemed like a daunting task was completed in hours. No one region of the country has been immune. Rural towns in Alaska, missile test sites in the Marshall Islands, military bases in Virginia, university towns across the country, and housing agencies in inner cities are all beginning to feel the cuts.


    You keep blaming the White House. Remember it's 98% what Boehner wanted and signed onto, and the generic Republican in the House still has not acknowledged how bad sequestration is, except when it hits home.

    http://www.huffingtonpost.com/2013/04/04/sequestration-2013_n_3010065.html?utm_hp_ref=politics

    So it sounds like you don't want Medicare cuts. Good for you.


    I see you keep avoiding the central question here - and that's whether or not the 2% could have had a minimal impact and whether Medicare is being run so efficiently so as not to have to cut areas that have such devastating impacts. Are you implicitly acknowledging that in fact the Obama Administration wants to "make it impossible to administer expensive chemotherapy drugs while staying afloat financially?"
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    Apr 04, 2013 3:49 PM GMT
    Most Medicare reimbursements to providers provide razor-thin profits, if any. Dialysis units, for example, LOSE money if they have too many Medicare patients (hence the cherry picking that often happens to get commercial patients). It does not take much of a cut to make it financially non-viable to accept Medicare patients.

    I'm saying that 2% might not sound much, but it's the margin of error that makes a big difference in this case. Would it be better if it was 1%? Probably. And no, when the across the board 2% cut is proposed, chemo patients were probably the last thing anybody thought of, since Medicare payments are so varied and diverse. Only when people sit down to do the specific math does it hit home.

    And yes, Medicare is THAT efficient in holding down payments, at least for the last few years. (E.g. it only takes 1 commercial patient to make it financially viable to treat 5 Medicare patients in our dialysis unit, but if you lose that 1, you lose money)
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    Apr 04, 2013 5:44 PM GMT
    Speaking of tumors:
    http://www.bloomberg.com/news/2013-04-04/tumors-on-ice-as-budget-impasse-freezes-medical-research.html

    I can hear Obama's evil laugh when he targeted those tumor tissues in the White House with "his" sequestration. It sounds like: Muhahahaha.icon_lol.gif
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    Apr 04, 2013 8:27 PM GMT
    q1w2e3 saidMost Medicare reimbursements to providers provide razor-thin profits, if any. Dialysis units, for example, LOSE money if they have too many Medicare patients (hence the cherry picking that often happens to get commercial patients). It does not take much of a cut to make it financially non-viable to accept Medicare patients.

    I'm saying that 2% might not sound much, but it's the margin of error that makes a big difference in this case. Would it be better if it was 1%? Probably. And no, when the across the board 2% cut is proposed, chemo patients were probably the last thing anybody thought of, since Medicare payments are so varied and diverse. Only when people sit down to do the specific math does it hit home.

    And yes, Medicare is THAT efficient in holding down payments, at least for the last few years. (E.g. it only takes 1 commercial patient to make it financially viable to treat 5 Medicare patients in our dialysis unit, but if you lose that 1, you lose money)


    And you think they couldn't have cut salaries? You think that Medicare is run so efficiently as to not have any waste? And yet you realize that public healthcare spending is already significantly more than what is spent per capita in Canada. How many people does public healthcare cover in the US? How is that working out?
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    Apr 04, 2013 8:49 PM GMT
    riddler78 said
    q1w2e3 saidMost Medicare reimbursements to providers provide razor-thin profits, if any. Dialysis units, for example, LOSE money if they have too many Medicare patients (hence the cherry picking that often happens to get commercial patients). It does not take much of a cut to make it financially non-viable to accept Medicare patients.

    I'm saying that 2% might not sound much, but it's the margin of error that makes a big difference in this case. Would it be better if it was 1%? Probably. And no, when the across the board 2% cut is proposed, chemo patients were probably the last thing anybody thought of, since Medicare payments are so varied and diverse. Only when people sit down to do the specific math does it hit home.

    And yes, Medicare is THAT efficient in holding down payments, at least for the last few years. (E.g. it only takes 1 commercial patient to make it financially viable to treat 5 Medicare patients in our dialysis unit, but if you lose that 1, you lose money)


    And you think they couldn't have cut salaries? You think that Medicare is run so efficiently as to not have any waste? And yet you realize that public healthcare spending is already significantly more than what is spent per capita in Canada. How many people does public healthcare cover in the US? How is that working out?


    Provider salaries has come down quite a bit on the order of 1-2% every year, if you haven't been following the rates, especially for specialties like CT surgery and radiation oncology, even before sequestration.

    OK, so we don't have universal government insurance like Canada. Our bad. But in the existing system, from what I gather above, you agree Medicare cuts are bad, no?
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    Apr 04, 2013 8:58 PM GMT
    q1w2e3 said
    riddler78 said
    q1w2e3 saidMost Medicare reimbursements to providers provide razor-thin profits, if any. Dialysis units, for example, LOSE money if they have too many Medicare patients (hence the cherry picking that often happens to get commercial patients). It does not take much of a cut to make it financially non-viable to accept Medicare patients.

    I'm saying that 2% might not sound much, but it's the margin of error that makes a big difference in this case. Would it be better if it was 1%? Probably. And no, when the across the board 2% cut is proposed, chemo patients were probably the last thing anybody thought of, since Medicare payments are so varied and diverse. Only when people sit down to do the specific math does it hit home.

    And yes, Medicare is THAT efficient in holding down payments, at least for the last few years. (E.g. it only takes 1 commercial patient to make it financially viable to treat 5 Medicare patients in our dialysis unit, but if you lose that 1, you lose money)


    And you think they couldn't have cut salaries? You think that Medicare is run so efficiently as to not have any waste? And yet you realize that public healthcare spending is already significantly more than what is spent per capita in Canada. How many people does public healthcare cover in the US? How is that working out?


    Provider salaries has come down quite a bit on the order of 1-2% every year, if you haven't been following the rates, especially for specialties like CT surgery and radiation oncology, even before sequestration.

    OK, so we don't have universal government insurance like Canada. Our bad. But in the existing system, from what I gather above, you agree Medicare cuts are bad, no?


    Hardly. I don't think all cuts are equal. Do you?
  • Suetonius

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    Apr 05, 2013 1:02 AM GMT
    it is hardly cost efficient for Medicare to cut payments to treating oncologists, and pay more for the same treatment to the hospitals that will be taking the patients. In other areas, Medicare is not following its own rules - the head of Medicare (CMS) (presumably on orders from the White House, recently chose not to implement cuts in reimbursements to physicians required under existing law, on the theory that Congress will probably change its mind in the future, and eliminate the cuts that it has already required. ("Mind" is probably not the right term to apply to the hacks which inhabit Congress, most of whom seem to be mindless.)
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    Apr 05, 2013 1:30 AM GMT
    Hospitals have cuts by sequestration as well. It's 2% across the board.
    http://csbj.com/2013/04/02/hospitals-brace-for-sequestration-related-cuts/

    If you read the article, it references this paper:
    http://glacialblog.com/userfiles/76/Milliman_Site_of_Service_Cost_Differences_Medicare_Exec_Summ.pdf

    The caveat in the end states that many factors are not assessed, including patient severity, physician/patient preference, convenience, etc.

    And no, not all cuts are made equal. The illogic of Congress accepting (even touting) the across-the-board cuts by sequestration is mindboggling. It was designed to be so distasteful that Congress would find a way around it. Instead we have many congressmen declaring that sequestration will not hurt, and cuts should be kept permanent...except in their own backyard.

    Physicians have prominent lobbyists too. Of course cuts are going to be delayed, just like the SGR cuts have been for years.
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    Apr 05, 2013 2:36 AM GMT
    q1w2e3 saidHospitals have cuts by sequestration as well. It's 2% across the board.
    http://csbj.com/2013/04/02/hospitals-brace-for-sequestration-related-cuts/

    If you read the article, it references this paper:
    http://glacialblog.com/userfiles/76/Milliman_Site_of_Service_Cost_Differences_Medicare_Exec_Summ.pdf

    The caveat in the end states that many factors are not assessed, including patient severity, physician/patient preference, convenience, etc.

    And no, not all cuts are made equal. The illogic of Congress accepting (even touting) the across-the-board cuts by sequestration is mindboggling. It was designed to be so distasteful that Congress would find a way around it. Instead we have many congressmen declaring that sequestration will not hurt, and cuts should be kept permanent...except in their own backyard.

    Physicians have prominent lobbyists too. Of course cuts are going to be delayed, just like the SGR cuts have been for years.


    Yep - prominent lobbyists who are undoubtedly encouraging their members to make the cuts appear as painful as possible wherever possible.
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    Apr 05, 2013 2:16 PM GMT
    Take it up with Boehner, who proclaimed that he got what he wanted with these cuts.
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    Apr 05, 2013 3:04 PM GMT
    http://griffin.house.gov/sites/griffin.house.gov/files/email.pdf
    http://www.thenewamerican.com/usnews/item/14695-leaked-e-mail-reveals-white-house-efforts-to-make-sequestration-hurt
    Wow, suddenly a field officer from the Agriculture Department becomes the official spokesperson for Obama on sequestration. What a stretch.icon_lol.gif

    If Congress wants to do whack-a-mole in ameliorating sequestration (i.e., restoring funding to prominent issues when they're brought to Congress' attention while ignoring other equally painful cuts that are not as "vocal" in Congress), it is welcome to do so.