ACCC Survey Shows Impact of Sequester Across All Sites of Service

ROCKVILLE, Md. – A recent survey by the Association of Community Cancer Centers (ACCC) of its membership shows that the 2% reduction to Medicare payments due to the federally mandated sequester is adversely affecting a majority of cancer patients and providers, including hospitals, physician practices, and all other sites of service.

The 2% reduction to Medicare payments went into effect on April 1, 2013, and cancer care providers most likely began seeing reduced payments in mid-April. ACCC’s survey opened on May 23, and results were compiled on June 11.

Of the nearly 200 respondents, 46% work in a hospital-based program and 39% in a physician office setting, with the remaining respondents from shared operations, freestanding cancer centers, or university-affiliated programs. Most respondents treat a patient population that is 26-50% Medicare (46% of respondents) or 51-75% Medicare (43% of respondents).

Survey respondents were asked if they had made any changes due to the sequester, and 58% responded yes. Of those, 78% said they were reducing operating expenses, including reductions in staff, while 35% said they were referring patients to other sites of service. Also of note, 13% and 14%, respectively, said that they had had to delay patient treatments or treat patients in a non-oncology infusion setting due to the payment reduction.

Respondents were asked what types of services have been most affected by sequester-related changes to their programs. Sixty-four percent said that chemotherapy infusion had been impacted. In addition, 30% have made changes to survivorship services, 30% to patient navigation services, 40% to nutrition and other complementary services, and 16% to clinical trials—all important components of quality comprehensive cancer care.

The sequester cuts are not just affecting Medicare patients. A majority of respondents (61%) reported that all patients, regardless of insurance, were being impacted by these changes. The sequester-mandated 2% cuts to Medicare reimbursement have affected navigation, survivorship, and other services that are utilized by all cancer patients. Just 10% of respondents replied that the cuts are only impacting Medicare patients without a secondary insurance.

Finally, ACCC sought to understand how the sequester has directly impacted patients. In the physician office setting, 32% said that their patients have not yet seen any changes to their care. However, a greater number of respondents, 35%, reported that the changes due to the sequester have meant more inconveniences for patients, including increased travel for treatment, more delays in treatment, and less continuity of care. An additional 4% of respondents said that they now have a policy in place to collect patient co-pays prior to the start of treatment, a stark change to how services have traditionally been provided.

In the hospital outpatient setting, 55% of respondents reported that the sequester has not impacted their patients directly, while 7% reported having to delay treatments due to the sequester. In addition, 15% reported that they were seeing more patients referred to their facilities.

"A cancer diagnosis is life-changing no matter what the circumstances. Patients do not need additional stress from discovering that trusted staff have been laid off or being told to seek treatment elsewhere," said ACCC President Virginia T. Vaitones, MSW, OSW-C, an oncology social worker.

The survey results clearly indicate a significant impact across all sites of service, from the hospital to the physician office setting. ACCC will continue to work with its membership to educate members of Congress on the impact these cuts are having on cancer patients and providers.