Medicare experiment would turn Illinois seniors into guinea pigs

Robin Madsen is exhausted from her ongoing battle with breast cancer.

"I wouldn't want to drive in the condition I'm in," admitted the Elgin resident.

Thanks to the American Cancer Society's "Road to Recovery" program, she doesn't have to. The program's volunteer drivers transport Madsen - and hundreds of other Chicago-area patients who can't drive themselves - to chemotherapy appointments.

Unfortunately, local efforts to ensure cancer patients get the care they need could be for naught if the federal government proceeds with its plan to slash payments to cancer care providers. The move would bankrupt Illinois cancer clinics and force doctors to turn patients away. Thousands of sick, vulnerable Illinoisans could be forced to travel great distances to receive lifesaving treatments. And some of the best therapies would cease to be available to all patients.

The Centers for Medicare & Medicaid Services, which oversees health care coverage for tens of millions of older and disabled Americans, is trying to implement a new reimbursement formula for drugs covered under Medicare Part B. These medicines, which mostly treat cancer and other serious diseases, are so strong that they must be administered under the supervision of a doctor. Physicians buy these drugs, administer them, and then bill Medicare for reimbursement.

The proposed formula would reduce reimbursements to clinics by thousands of dollars per patient. Physicians administering a standard breast cancer treatment regimen would receive almost $3,500 less under the new plan. For a typical blood cancer treatment plan, the cuts would be closer to $4,000.

For dozens of medicines, the reimbursement rate would be so low that doctors would lose money each time they administer the drugs.

Community oncology clinics won't be able to continue caring for patients in the face of such losses. A previous round of reimbursement cuts in 2013, which was less severe than the current proposal, forced 50 percent of community oncologists to turn away Medicare patients and send them to other providers.

Many patients had no choice but to drive further to hospitals where care is more expensive.

The new cuts would repeat that disaster, disrupting treatment for thousands of Illinois' most vulnerable citizens.

The cuts would effectively limit which providers patients can visit - and also restrict which treatments they can receive. Because the new formula would cut reimbursements for advanced therapies the most, some clinics might only be able to offer older medicines.

That would harm patients' survival chances and reverse decades of cancer-care progress. Thanks largely to new and better medicines, the cancer mortality rate in Illinois has dropped 22 percent over the past three decades.

Depriving patients of today's most advanced medications would also stymie the creation of tomorrow's therapies. That's because Medicare would cease to be a major buyer of new drugs. Without a sufficient market for such medicines, pharmaceutical companies would conclude that creating advanced new cancer drugs isn't financially feasible - and slash research and development budgets as a result.

Officials at the Centers for Medicare & Medicaid Services are proposing the health care equivalent of an education policy that forces teachers to pay for their students' books and supplies - and reimburses them less than those materials cost. The resulting school closings would force students to travel long distances, deprive them of needed learning materials, and discourage people from becoming teachers. The dire long-term consequences wouldn't justify any short-term savings.

Likewise, the proposed reimbursement cuts would force local cancer clinics to turn away Medicare patients or close their doors. That would deprive patients of lifesaving medicines and force them to travel long distances to receive care.

In short, the policy would put cancer patients on the road to ruin, not the road to recovery.

Michelle Orive, of Wheaton, is president of Rush to Live in Illinois.