Clinic Cutbacks Hurt Cancer Patients

According to Medicare statistics, the number of oncologists signed up for Medicare has grown from 6,878 in 2006 to 7,831 in 2010. However, this increase in numbers may be deceiving. "Our concern is that these small practices are struggling and are going to go away and leave patients without good access to services in their communities," says Deborah Kamin, senior director of cancer policy and clinical affairs at the American Society of Clinical Oncology.

Just a week before her husband died in October, Judy Smith of Turkey, N.C., described how the cancer clinic 15 minutes away in Clinton, N.C., couldn't provide chemotherapy to her husband, Leroy, because he only had Medicare and no supplemental insurance to cover the 20 percent copayment. As a result, the couple had to make an 84-mile round-trip drive to a hospital in Goldsboro.

High costs for oncology practices

Bo Gamble, administrator for the Southeastern Medical Oncology Center, whose Clinton, N.C., clinic provided most of Smith's other cancer care, says that because of ongoing cuts in Medicare reimbursements, the center's five locations in eastern North Carolina have had to send about 10 percent of patients elsewhere for chemotherapy.

Of about 60 types of physicians' practices that responded to a cost survey, hematology/oncology is the most expensive to operate, with an annual median cost of more than $2.9 million in 2009. This is primarily because of drug costs, according to the Medical Group Management Association, which conducted the survey. 

Gamble explains that their locations employ 3 1/2 full-time patient advocates who try to find foundations and other programs to help cover patients' copays, provide medications or assist with utilities and grocery expenses. However, he says, "more and more of these programs are running out of funds because the demands for funds are exceeding the supply."

Oncologist Clinton Merrill, M.D., closed the doors of his eight-year-old practice in Laramie, Wyo., because more than half of his patients were on Medicare, and each month reimbursement rates were falling far behind his costs, he says. "In any single month, chemotherapy drugs were between $200,000 and $400,000. Our payer mix was poor, too many patients with no insurance, and in early summer we sat down and realized we were losing about $30,000 a month." He says that of the 200 patients he served, some will be treated at the local hospital. Others will travel to see him in Nebraska, where he begins working this month.

Meanwhile, the families soldier on. Becky McCray says that besides having to travel so far for her husband's cancer care, the couple also have at least $7,000 in medical bills—something she doesn't allow herself to dwell on.

"It's more important getting him well and back on his feet," she says. "If we can get that going, we'll worry about the rest.

Laurie Udesky is a writer in San Francisco.