COA Letter to President Obama on Cancer Crisis

Copy of a letter sent by COA President Patrick Cobb, MD to President Obama

President Barack Obama
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

Dear Mr. President:

We strongly support your guiding principle that health care reform must “build on what works and fix what is broken.” Unfortunately, that is the exact opposite of what is happening with our country’s cancer care delivery system. Recently announced cuts to Medicare reimbursement for cancer care by the Centers for Medicare & Medicaid Services (CMS) will accelerate the cancer care crisis already created by a broken Medicare payment system. On behalf of the Community Oncology Alliance (COA), a non-profit organization representing the interests of community oncology practices, I am writing to ask you to work with us to urgently address this crisis as part of health care reform.

Although health care reform is critically needed, the United States has the best overall cancer care in the world as documented by five-year survival rates — a true measure of performance. The success is due in large part to earlier cancer detection, more precisely targeted therapies, and unparalleled access to quality, compassionate cancer care. During the past twenty-five years, cancer care has evolved to the outpatient, community setting, where now over 80% of Americans battling cancer are treated. Even with this success, we should strive to better enhance the quality of cancer care, while looking for ways of controlling increasing costs.

The problem is that the Medicare payment system for cancer care is simply broken. Dr. Robert Fein, a medical oncologist practicing in Somerset, New Jersey, stated it best in these excerpts from an editorial he penned recently for the (New Jersey) Star Ledger.

“The cancer care delivery system is broken. It has reached the point where medical practices cannot stay in business and patients often cannot afford necessary treatments.

Over the past 2 to 3 years, Medicare has consistently lowered reimbursement for chemotherapy drugs and administration to oncologists. Additionally, Medicare does not reimburse for essential services such as treatment planning and care coordination.

As further cuts occur, physicians cannot continue to shoulder losses... As we reform health care, we must address the plight of cancer patients… Just as I would treat a sick patient, we must fix a broken system, starting with Medicare.”

Under the watch of the previous Administration, CMS failed to deliver on the congressional intent of the Medicare Modernization Act of 2003 relating to cancer care funding. As a result, Medicare not only significantly underpays for the critical services involving the administration of life-saving cancer drugs, but does not reimburse for essential services such as treatment planning and care coordination. Now, CMS is pursuing a course of action, based on insufficient and inaccurate data, which will further severely cut payments for cancer care.

We hear your request to the medical community to help pay a portion of the price for health care reform. Community oncology practices have already contributed more than their share by shouldering Medicare payment cuts in excess of 25% over the past 5-6 years. Additional cuts, as now planned by CMS, are simply unrealistic — they will truly accelerate the dismantling of the nation’s cancer care delivery system. If a “public” insurance option is created based on Medicare — or even 5-10% above Medicare rates — and results in private insurers lowering their payments accordingly, practices simply would have to close their doors. This is borne out by modeling work recently completed by several large practices.

Despite these challenges, we are committed to being a part of the solution. Over eight months ago, COA convened a task force of practicing oncologists to analyze ways of improving the quality of cancer care while controlling costs. The result of that effort is embodied in legislation that was recently introduced in the Congress by Representatives Artur Davis, Steve Israel, and Mary Jo Kilroy — the Medicare Quality Cancer Care Demonstration Project Act of 2009 (H.R. 2872). This bill would create a national cancer care demonstration project, open to all oncology clinics, dealing with active treatment and end-of-life care — the latter something you highlighted during your recent White House forum on health care reform. This national project would refine quality metrics dealing with recognized, evidence-based treatment guidelines and patient-centric, coordinated care. Centered on quality and cost efficient medical care, this demonstration project can be implemented without major infrastructure changes. It is intended to result in a new payment mechanism that incentivizes quality cancer care delivery that controls cost. Additionally, COA will actively involve community cancer clinics already using electronic medical records to bring information that would augment data collected by the Medicare system. As such, this is not only a real-life application of health information technology, but also the type of public-private collaborative effort that will be necessary to truly reform the health care system.

Last week, over 100 oncologists, nurses, administrators, patients, caregivers, and survivors came to Capitol Hill to discuss the crisis in cancer care. Following this legislative day, the cancer community across the country will now be making a massive outreach to their members of Congress to further discuss the crisis, recent CMS planned cuts, and specific solutions such as embodied in the demonstration project summarized above.

With all of our success, cancer is still the second leading cause of death in this country, claiming on average the life of one American every minute. Additionally, the incidence of cancer is increasing, but we are losing oncologists relative to demand. By 2020 we will be short an oncologist for every one in three cancer patients.

We need to act immediately to fix the broken Medicare reimbursement system for cancer care — and not make it worse by implementing a new round of planned payment cuts. Furthermore, basing a “public” insurance option on a broken Medicare system for cancer care, without first fixing it, will be catastrophic. COA pledges that cancer clinics across the country will work together to increase the quality of cancer care while controlling costs; however, we need your leadership to help overcome the immediate crisis that is now dismantling what has worked so well for our patients. Our ability to treat the current and future generations of Americans battling cancer hangs in the balance.

Sincerely,

Patrick Cobb, MD
President