Oncologists Fight Back

Among those most dissatisfied when President Bush signed the 2003 prescription drug law were private-office oncologists. Thanks to the laws, the oncologists now join malpractice premium-embattled OB/GYNs, surgeons, and others in finding their ability to practice medicine is becoming almost impossible.

Oncologists unsuccessfully challenged a new reimbursement scheme included in the legislation that significantly decreases payments for drugs they administer in their offices.

The plan, phased in over three years, also includes increases for physician services, but the cuts are much deeper. Oncologists say that when the new payment structure is fully implemented, many of them will no longer be able to practice. 

Luckily for their patients, they're not giving up.

In several U.S. cities there has been shifting of staff and even some layoffs. Beyond that, some oncologists are mailing letters to patients warning that if the new policies remain, they may have to return to hospitals for their treatment, receive older and more invasive drugs, and even risk losing the care provided by their private physicians.
Medicare officials slam these warnings as scare tactics, saying physicians' claims are unfounded.

Congress made the changes as a way of reforming an oncology compensation system that almost everyone admitted was haywire. The measure passed by Congress and signed by the President is intended to create a "reimbursement system that accurately reflects medical services and drugs used."

But the meaning of that phrase varies depending on your perspective, and whether you're a physician, a patient, or the government.

As a spokesperson for the Center for Medicare and Medicaid Services (CMS) told one newspaper, "for years it has been agreed that doctors have been overpaid."

Overpaid? Come again? American physicians are the most highly trained, over-regulated, under-compensated professionals in the U.S. relative to the positive impact they have on people's lives.
The new law, originally said to cost $396 billion, will actually cost $530 billion, the administration now concedes. Advocates for oncologists fear that the government is trying to make the law slightly more affordable on their backs.

As if that were not bad enough, oncologists are finding that not only will their revenues be cut, but their discretion to practice medicine as they believe necessary for their patients is also being undermined. CMS may curtail reimbursements for some of the most successful -- and unfortunately, expensive -- off-label drugs. The agency says it may be another necessary cost-cutting measure.

As huge federal and state budget deficits continue to stare policymakers in the face, patients and physicians will be asked to make compromises. It's incumbent on you to educate your patients about these hard choices so they can help elected officials make wise decisions. It will not always be pretty.  

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This article originally appeared in the May 2004 issue of Physicians Practice.