- The Washington Times - Friday, June 4, 2004

Physicians inspire respect, even awe in our culture, which might explain why some oncologists think they can shock the public into believing much-needed reforms in Medicare will destroy community cancer care.

Gloomy reports of doctors who fear the new economics of Medicare will compel them to send patients to impersonal, faraway hospitals for chemotherapy, rather than treat them in close-to-home cancer centers are sprouting like springtime weeds in newspapers across the country.

But there is a lot the doctors are not telling the American people — perhaps, as the New York Times complained, because they want to scare patients as a way of preventing reform.

The Medicare Modernization Act of 2003, along with new prescription drug benefits for seniors, changes the way government reimburses oncologists for medications used in outpatient settings. The change take effect on Jan. 1, 2005, and not a day too soon for taxpayers and seniors.

Under the old, perverse system, oncologists are a privileged class of specialists. Medicare massively overpays these specialists for the cancer drugs they administer while providing modest reimbursement for the administrative costs associated with community cancer treatment, such as support staff, counseling and transportation.

The Health and Human Health Services inspector general and the General Accounting Office (GAO) in scathing reports projected about $1 billion annually in drug over-reimbursements and nearly $300 million in excess copayments seniors have had to pay. These bloated reimbursements are based on a cancer drug’s “average wholesale price” (AWP), a figure like the sticker price on a new care which, in the words of the GAO, “is neither an average nor a price that wholesalers charge.”

The new Medicare law sensibly replaces AWP with the real-world average sales price of a drug. At the same time, the law increases the allowance for administrative costs.

Even given the charitable view that $300,000-a-year (or more) oncologists have been plowing the difference between their Medicare reimbursements and what they pay for cancer drugs into nursing, counseling and other patient services, it is clear the 2003 law provides a much-needed fix for Medicare, patients with excessive co-payments and taxpayers.

Some groups with a stake in this issue already are trying to convince Congress to undo this rational legislation. One campaign, led by the oncologists, aims to reopen the law and change its careful balance and multiple reforms.

That is why we are reading stories about the end of community cancer care as we know it, featuring worried physicians and panicked patients and relatives.

Though the Medicare Modernization Act is not perfect, I would rather live with it unchanged than open it to amendments just to please the elite oncologists.

With all due respect for the skill and knowledge of the profession, there are oncologists who have become dependent on an irrational and wasteful system that leaves both taxpayers and seniors picking up an unfair share of the tab. In the bigger scheme, the overall Medicare Modernization Act will be gutted by tinkering, grandstanding and budget-busting if amendments are allowed.

Congress and President Bush should be applauded for expanding benefits and eliminating government waste while working to make Medicare more cost-efficient and more quality-focused. Rather than allow special-interest groups to force a new, nonproductive debate on payouts under the Medicare law, Congress should see that the Center for Medicare and Medicaid Services implements the new law in a speedy and fair manner — just as it is.

A Bronx cheer goes to those oncologists who are spreading misinformation about the consequences of the new Medicare reimbursement rules to their patients and the media. Scaremongering physicians should consider what damage their tactics might be doing to the reputation of the oncology profession from Capitol Hill to Main Street.

Seniors trust physicians. It is time some oncologists repaid that trust with a dose of honesty.

James L. Martin is president of the 60 Plus Association, a nonpartisan senior citizens’ organization in Arlington, Va.

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