Seeking Fine Surgical Cuts Under Sequestration, Not Blunt Hacking

Dawn Holcombe, MBA, FACMPE, ACHE
Editor-in-Chief
President, DGH Consulting, South Windsor, CT

Politics makes extreme messes. While Congress and the administration continue their political lunging and feinting (not to mention grandstanding), cancer care providers are hunkering down, buying drugs, and caring for patients with cancer.
Here is our biggest challenge: the looming “sequester” cuts for Medicare may—or may not—be applied to drugs. If the 2% cuts are applied to services, that is one thing. We, like every other service that will be affected by the cuts, can move staff, hours, and resources around to adjust to the cuts. The fact of the matter is, we will not have a choice.

However, if the 2% cuts are applied to drugs—which we buy to stock our inventory, and therefore need to recoup at least the costs of the drugs that we use for Medicare patients—those of us who care for patients with cancer will not have the flexibility to adjust. Drug costs are direct out-of-pocket losses that no cancer program, whether hospital-based or private practice–based, can absorb.

As always, the devil is in the details. The Health Resources and Services Administration has the ability to announce how the final total sequester cuts are applied, and to which line items those cuts will apply. We have a very short window in which to illuminate the differences between cuts to services and cuts to purchased product reimbursements that do not change the prices we pay for the product.

Every cancer program in the country that accepts Medicare reimbursement under the Part B program now has this critical chance to shine the spotlight on the difference between the services provided to Medicare patients and the drugs that need to be purchased and provided to those patients. We need to let our congressional representatives —both senators and representatives alike—know that drug reimbursement prices are set based upon a legislated schedule, and that the sequester cuts should not be lumped together with services.

We all need to be aware that, right now, every program and service—including programs in education and defense—across the nation is actively lobbying Congress and Medicare to avoid cuts in their respective areas, with everyone at risk citing dire consequences if their programs and services are among those that will take a hit. Because of the magnitude that the sequestration cuts possibly hold for every program and service that may be affected, those of us who care for patients with cancer need to be incredibly focused in our own messages, and we need to present a rational argument that objectively distinguishes between the hardships that will be created with cuts to cancer drugs as opposed to the hardships created with cuts to cancer services.

Several national groups have joined forces to present a common message to our federal decision makers. Whether you are a hospital-based or private practice–based group, please take a look at the requests that national groups such as the American Society of Clinical Oncology and the Community Oncology Alliance are making. Place the phone calls and write the e-mails to your district’s congressional representatives—and engage your patients as well. This is not about saying “do not cut”—that boat sailed when the sequestration went into effect. It is about saying “apply the cuts discriminately and intelligently.”

So call your legislators today, and set up phone systems in your offices so that your patients can call their legislators, too. Remember that we are fighting a massive tidal wave of pleas from many groups and interests to not make cuts in other areas of the budget. Our voice must be clear, loud, and constant—and it must be immediate.

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