Fears voiced on Bush Medicare plan

WASHINGTON -- Cancer doctors and patients' advocates said a Bush administration proposal to cut Medicare payments to cancer doctors could force a dramatic change in care, with patients forced to get treatment in hospitals, sometimes far from their homes, rather than in physicians' offices.

"A patient of mine in rural Illinois may have to drive another 50 miles," said Dr. Edward Braud, an oncologist who was interviewed by telephone from his clinic in rural Jacksonville, Ill.

The White House detailed its proposal on cuts in payments for drugs to treat cancer and chronic lung ailments yesterday, saying taxpayers had been paying the physicians up to twice what they should for certain medications.

The proposed changes would save the government $530 million and Medicare beneficiaries $270 million next year, said Mark McClellan, administrator of the Centers for Medicare and Medicaid Services. Medicare spent $10.5 billion last year on prescription medicines administered in physicians' offices and clinics.

Cancer specialists said they relied on the higher drug payments to cover chemotherapy-related services that Medicare did not fully fund. If the proposed cuts take effect, physicians might lose money and stop offering cancer care, said Deborah Kamin, senior director for cancer policy and clinical affairs at the American Society of Clinical Oncologists.

Cancer specialists' revenues could decline up to 8 percent, McClellan said. Payments for some treatments for prostate cancer would be cut in half. Drugs dispensed in doctors' offices to treat lung illnesses, for which Medicare pays 90 percent more than the sales price, also would be affected by the proposed changes, he said.

Doctors have long acknowledged that the payment system has been out of whack for cancer care administered in their offices. Several studies have documented that drug reimbursements were tied to an inflated price rather than to what doctors paid. Yet the government allowed the overpayments to continue because it acknowledged that doctors were underpaid for their practice expenses.

The proposed regulations issued yesterday also would set the terms for introductory physical exams and other new preventive screenings for Medicare patients; boost payments to physicians in areas with substandard medical help; and increase doctor payments generally by 1.5 percent to an estimated $55 billion next year.

Chemotherapy medicines and other injected drugs given in a doctor's office are among the few medicines the program now covers. The changes in cancer-drug reimbursement were mandated by the last year's Medicare law, which also directs Medicare to provide full prescription drug benefits starting in 2006.