Since the passage of the Budget Control Act, which was designed to control spending by capping defense and nondefense discretionary spending, there have been attempts to avoid the dramatic cuts established by the law to achieve certain spending targets. Specifically, a bipartisian, bicameral committee was created in 2011 to find a balanced deficit reduction plan, which we now know did not happen and ultimately led to the sequester going into effect in 2013.
Sequestration impacts healthcare by cutting funding to the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention, the National Institutes of Health, and the Affordable Care Act programs. While each of these cuts impacts community oncology, this article addresses exclusively the 2% across-the-board reduction to Medicare reimbursement.
The 2% across-the-board Medicare sequester, which applies to everything billed to Medicare—including drugs—has been squeezing the oncology community since the CMS implemented it in April of 2013. Shortly after the sequester began, the Association of Community Cancer Centers (ACCC) surveyed its membership across various sites of care and found that nearly 60% of the respondents reported being impacted by the reduction in reimbursement. In October, when sequestration hit the 6-month mark, the ACCC conducted a follow-up survey of its membership to see how cancer programs were coping and whether the picture that had been painted at the start of the sequester still stood. The results of the follow-up survey highlight some interesting points about how the sequester is still impacting community oncology care.
Two thirds of the survey respondents report being impacted by the sequester. Of those impacted, 84% are making adjustments to operating expenses, including reducing staff hours or not replacing staff when they resign. The follow-up survey results show that the fastest growing area seeing cuts is nonrevenue-generating programs, such as patient navigation services. Reducing these services hinders the quality of care for all patients with cancer because these programs help patients with financial issues, dietary requirements, cultural barriers, health literacy, and other needs. Because these programs assist all of the patients in a particular cancer program, it is not surprising that 75% of the respondents said that the sequester is impacting every single one of their patients, regardless of the fact that the 2% reduction in reimbursement is only applied to Medicare claims directly. This is an increase of 15% from the initial survey on this question, which indicates that some of the broader implications of sequestration are just now beginning to surface.
Interestingly, of those who had not yet made changes in the follow-up survey, 25% responded that they did not expect to make changes in the future, compared with the 14% who reported the same in the original survey. This may be good news, in that it may be possible that more cancer programs are finding ways to adjust to these reimbursement reductions without making changes to patient care.
Taken together, the results of these 2 surveys show that more cancer facilities are being negatively impacted as a result of the sequester, and that the cuts have impacts far beyond Medicare patients—they extend to all patients with cancer, cancer center staffs, and supportive care programs. Additionally, these surveys show that many ACCC members are resourceful and are coming up with innovative solutions to continue to care for their patients.
However, providers are also at the end of their rope—community oncology care cannot be cut further and the sequester must be reversed to preserve patient access to the supportive care services that relieve barriers to care, increase value, and help to reduce long-term costs.
The ACCC continues to encourage Congress to protect patient access to care by protecting community cancer care reimbursement, and will continue to push for a reasonable solution to the Medicare sequester. As always, we will keep members up to date on changes to this important issue.