What’s Standing Between Us and Our Patients?

Patrick J. Donovan, MD, FACP
TACOS President

As I thought about writing this column, I was struck by the fact that despite the change in time, “the more things change, the more they stay the same.” When I first served as president of TACOS, the Clintons were crisscrossing the country campaigning to continue living in the White House—just as they’re doing now. Once reelected, the Clinton Administration set out to revamp Medicare and save it for future generations. Instead, we got the now infamously flawed “sustainable growth rate” or SGR, which has left doctors who treat Medicare patients struggling to keep their practices open or unable to see these patients at all.

Meanwhile, Congress’ solution has been a series of partial measures requiring last minute action to simply prevent real dollar cuts to the front-line practitioners. In the last three years, while total healthcare spending has increased at an average of nine percent per year, Medicare payments are now only temporarily at a 0.5 percent total increase over three years, and the cut this year may be as high as 10 percent. This is clearly neither sustainable nor growth.

Under the MMA, reimbursement for some chemotherapy or supportive drugs is now less than the cost of purchasing them. And in the name of quality improvement and curbing over-utilization, some third-party insurers will not provide authorization for services unless multiple-page questionnaires are filled out; likewise, some local carrier Medicare Directors refuse to cover the use of such essential tools as PET or CT unless and until certain prescribed guidelines have been met.

What can be done about these and other problems with the healthcare delivery system? Well, once again I see a parallel between the present and the past. I am reminded of a movie from my past, "Network," in which the hero, Howard Beal, encourages people to throw open their windows and shout, “I am mad as hell, and I’m not going to take it anymore.” My fear is that until all parties get involved, providers, patients, families, organizations, and not-for-profit groups that have an interest in ensuring that cancer patients receive quality healthcare, nothing will change.

It is my hope that through the cooperative and collaborative efforts of local-level organizations such as TACOS and the national associations that advocate for quality oncology care, such as ACCC, ASCO, and ASH, the insurance executives, government officials, and other concerned forces may come to recognize how some of the current decisions are interfering with the effective and compassionate delivery of cancer care. This is why it is important for us as providers to answer the calls of our national organizations and take every opportunity to educate our state and national policymakers on the advances that have taken place in oncology care and how public policies may inadvertently be interfering with these advances. Stay tuned for my next message—the importance of individual and collective advocacy for quality cancer care.

You can begin the year advocating for quality cancer care by joining us at the TACOS spring membership meeting and learning about the latest developments in reimbursement and legislative/regulatory actions. The meeting will take place on April 19 at the beautiful Pointe Hilton Tapatio Cliffs Resort.

Please click here for additional information and to register for the meeting. See you there!