There's a misguided cost-cutting plan being discussed on Capitol Hill that could severely jeopardize the health of millions of rural Americans. Community cancer clinics across the country could be forced to shut down, leaving many patients living outside of major cities without anyone to treat them.
This plan centers on Medicare Part B, the component of Medicare that covers services provided by doctors, generally in their offices. This includes the special class of medications that need to be administered in a doctor's office.
For diseases such as cancer, rheumatoid arthritis, and multiple sclerosis, the prescribed treatment regimens generally are infused or injected therapies and require physician supervision for the sake of safety and efficacy.
Under the current system, physicians pay for these drugs themselves, treat the beneficiary, and then bill Medicare. They are then paid under a formula -- roughly, the prevailing average market-based price of the drug plus a percentage add-on to cover administrative costs.
Caught up in the push for a federal fiscal clampdown, Congress is looking to slash Part B's reimbursement rates for a select group of doctors, chiefly oncologists, rheumatologists, and other specialists who use these medicines as key components of treating diseases.
These so-called "savings" would come at a huge cost to patient health -- and the healthcare system generally. And the hits would fall heaviest on people living in rural America.
Many doctors already face no or very small margins when treating Part B patients. MedPAC has described these margins as "slim" for most doctors and notes that there are even "some drugs [physicians] cannot purchase at the payment rate" because it's already too low.
For many doctors, further cuts to Part B reimbursements would make it completely financially unsustainable for them to continue to treat patients. In an understandable effort to stay afloat, many will restrict the number of new enrollees they treat or opt out of Medicare entirely. Available clinics will dry up. And patients will face longer wait times, extended travel times to receive treatment at regional medical centers instead of their communities, restricted access to care, and additional risks to their health.
These effects are going to be felt everywhere. But they will be particularly pronounced in rural areas. Small, rural clinics face higher drug acquisition costs than their big-city counterparts. That means these doctors will have little room to maneuver if rate