You may have heard that White House tours were cut due to across-the-board federal spending cuts known as the sequester. Or that Congress made sure to minimize disruptions to air travel. Or perhaps you know someone being furloughed as a result of the cuts.
But did you know a major fight is being waged over sequester cuts to some cancer drugs?
After Congress failed to pass a budget this spring, a 2 percent cut to Medicare chemotherapy drug reimbursements went into effect April 1 as part of the across-the-board federal spending cuts designed to save $85.4 billion this year.
Many doctors and patients are infuriated, and the issue has made its way into Congress, with a bill introduced in the House to help alleviate the burden being put on those in the cancer community.
Dr. John Cox, a community oncologist at Texas Oncology Methodist Cancer Centers in Dallas and a member of the American Society of Clinical Oncology (ASCO), told Yahoo News that the idea of treating Medicare patients differently from other patients goes against everything for which doctors stand.
"It makes all of us uneasy when we realize we are treating different populations in our practice differently," Cox said.
The pressure put on doctors is significant. Oncologists are typically reimbursed the average sales price for chemotherapy drugs plus 6 percent to cover the cost of storing and administering these drugs. Because purchasing those drugs costs the same as it did before the sequester, many cancer doctors, especially community oncologists who operate in smaller, nonhospital settings—are now unable to keep up with the costs associated with treating Medicare cancer patients who are typically elderly and on fixed incomes.
Indeed, studies from various oncology groups bear out a negative trend: Due to the sequester cut, community practices have begun to turn some people away or to close their doors entirely, shifting patients to hospitals for their chemotherapy treatments where the infrastructure is larger, costs can be better absorbed and some drugs can be purchased for less.
A May 9 survey from the Community Oncology Alliance found 49 percent of respondents were sending Medicare patients elsewhere, with many more planning to begin doing so; 21 percent of practices were laying off staff; and 14 percent were in talks with hospitals about forming alliances.
A new survey from ASCO found that 80 percent of respondents say the sequester has affected their practice. Nearly 50 percent said they wouldn't be able to continue caring for Medicare patients who didn't have supplemental insurance, and 50 percent had begun sending patients elsewhere, primarily to hospitals.
Some doctors say that the shift to hospitals could be detrimental to Medicare patients' care due to less personalized service, personal mobility issues and the typically higher overall cost of treatment at a hospital.
"I'm sure that there's some people who say that they are enraged," Dr. Jeffery Ward, a community oncologist at Swedish Cancer Institute in Edmonds, Wash., told Yahoo News of the cut. "I'm just saddened that our government system is so completely inept that they will take the most fragile and vulnerable people in our society and hang them out to dry—and that's what Congress and our government has done."
Ward said that his practice as a result of the crush of costs—which in addition to the sequester cut includes a shrinking reimbursement system and a Washington state business and operations tax—formed a nonprofit and became part of a local hospital group on April 1. It's a fate he says will become more common under the sequester.
He added that he and his patients are among the luckier ones: Not only can his new hospital group help with costs, but the convenient location means his doctors can continue treating the same patients. But he noted that others might not be as fortunate, especially those in rural areas.
"If you're in a situation where [a] hospital is not willing to work with you or does not wish to take on cancer care, or if you're operating a long ways from a hospital, those are places where clinics may end up closing their doors and where patients will be disadvantaged or put out," Ward said.
Cox said some of the talk about the damaging impacts of the sequester from the oncology community might be hyperbole, but negative effects are real and contributing to an already crushing system of physician reimbursement, in his opinion.
"We have not changed any practice, at least that I’m aware of, in our group because of the 2 percent sequester," Cox said of his larger practice. But he said that fact belies a gradual "belt-tightening" and "dramatic" changes in outpatient medical oncology.
If the cut remains and other financial pressures continue to ramp up, he added, his group will reevaluate its ability to operate outreach centers and conduct clinical research work.
"Fiscally, I want people to be responsible, but taking a blood axe to the federal budget and doing it broadly across the board seems crazy to me," he added about the sequester.
Similar opinions were expressed earlier this year about the Federal Aviation Administration (FAA) air traffic controller furloughs under the sequester, which threatened to result in the cancellation of flights and disruption of air travel for millions, as well as the closing of some airports.
Congress asked the FAA to step in and shift money to avoid furloughs, but the government said it had no authority to do so. As a result, Congress united and passed a bill to give special permission to the FAA to transfer money within its budget and cut elsewhere to avoid furloughs to air traffic controllers.
Members of Congress have urged the government to make a similar exception to protect cancer drugs from the sequester.
Members of the Senate and House sent letters—124 House members to the Centers for Medicare & Medicaid Services (CMS) and Republican Sen. Pat Toomey of Pennsylvania to the Department of Health and Human Services (HHS) —asking if officials could exempt cancer drugs.
The 124 House members who wrote CMS received their response last Wednesday, and it wasn't encouraging.
From Marilyn Tavenner, administrator of the CMS:
The Department of Health and Human Services assessed whether the law allows discretion to administer the sequestration reductions in a manner that is different from the across the board approach that has been used to implement it. We do not believe that we have the authority under the Budget Control Act of 2011 to exempt Medicare payment for Part B drugs.
That response appears to put the onus on Congress for a policy solution.
North Carolina Republican Rep. Renee Ellmers, a former registered nurse—who supports the sequester's aim to reduce federal spending, but not its indiscriminate cuts—introduced in early April a bill to exempt cancer drugs from the sequester and to force Medicare to reimburse oncologists for the reduced payments they have so far been issued under the sequester.
She told Yahoo News last week that she believes Tavenner's response, while disappointing, boosts the argument for her legislative fix.
"I feel that this will increase the number of co-sponsors quickly," Ellmers said of the CMS response. Indeed, supporters believe that some members were awaiting a formal response from the government before signing on to Ellmers' bill.
Ellmers said she picked up two co-sponsors the day after Tavenner's letter was released—"probably the result" of the response from CMS. She ended the week with four additional co-sponsors, putting her total at 85 supporters from both parties as of late Friday.
Supporters of Ellmers' bill say that much like the FAA fix, this legislation has the potential of being passed due to wide bipartisan support.
"Needing those spending cuts to me was the ultimate goal, but at the same time when you realize that you've hurt vulnerable individuals, that's when you need to make the changes," Ellmers said. "And that's what we should be doing here in Washington. ... If we see that we've affected someone on a personal level as an unintended consequence of something that we've done, then we need to fix that problem."