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Clinic Cutbacks Hurt Cancer Patients

Office closings and staff trims hamper access to care for oncology patients who lack full insurance coverage

Tommie McCray, 69, a carpenter in Selma, Ala., made the birdcages, end tables, china hutches and other handcrafted furniture that adorn his house and those of his children. "You show me a picture of it, and I'd build it," he says. 

But in recent months his greatest effort has been making the 110-mile daily round trip from Selma to Alabaster, Ala., for radiation and chemotherapy treatments after the cancer clinic near his home closed its chemotherapy section last April. McCray, who has esophageal cancer, also requires oxygen for emphysema and chronic obstructive pulmonary disease, and he is fed through a tube.

For each of the five days a week he traveled for treatment, it was like "packing for a trip," says his wife, Becky, who drove him to all his medical appointments. "I'd have to bring his oxygen, his medication, all this equipment." On top of that, she says, McCray would sometimes be ill from nausea along the way. "You worry about what are you going to do if there's a flat tire," she adds. 

Having to transport her husband to a remote cancer treatment center every day is also part of the reason Becky McCray lost her job at a local grocery store, along with her employer-sponsored health insurance. She also had to drop out of a four-year college program in business administration. "If we still had the cancer clinic in Selma, she probably wouldn't have lost her job," says her husband.

Drug costs, economy fuel closings
The closing of the chemo section of the Selma cancer practice is not an isolated case. More and more cancer practices have been forced to cut back or close their doors, according to the nonprofit Community Oncology Alliance, which says 41 clinics had closed nationwide by July this year. Oncologists or cancer center staff and their membership organizations blame closures and cutbacks on exorbitant drug costs, a tattered economy, Medicare reimbursement cutbacks, and the clinics' inability to absorb expenses for patients who lack full insurance coverage. As a result, an untold number of cancer patients like McCray must travel greater distances for treatment.

And that's not the worst of it: Some 2 million of 12 million cancer patients in the United States have had to delay or forgo treatment because of cost, according to a recently released study in the journal Cancer

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.

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