Other Views: Payment cuts would hurt seniors' health care

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Corinna Silberg
Friday, April 7, 2017

Wisconsinites battling cancer and other serious diseases may soon struggle to get the treatments they need.

In recent years, four local cancer clinics shut down or turned away patients they couldn't afford to treat. Many family doctors and specialists are under similar financial strain due to razor-thin reimbursement margins from Medicare. Now, a federal panel wants to further reduce Medicare payments to these providers. That could force even more clinics and practices to close or to turn away patients seeking life-saving treatments.

Specifically, officials on the Medicare Payment Advisory Commission—MedPAC—just released a set of proposals that would cut reimbursements for Medicare Part B, which covers services and drugs administered in clinics and doctor's offices. Under Medicare Part B, healthcare providers buy treatments up front. They then bill Medicare for reimbursement. Medicare pays the average price of the drug plus a small add-on, which helps cover administrative expenses.

MedPAC recommends cutting this add-on in half. For many smaller clinics and medical practices, that could entail a loss of thousands of dollars. Patients would suffer from these cuts. If smaller medical practices and clinics are forced to close or merge with hospitals due to financial problems, people across Wisconsin will have a harder time accessing care. The changes will particularly harm the quarter of Wisconsin citizens who live in rural areas, as well as seniors with limited mobility. For these patients, there is a world of difference between driving a few miles to a local clinic versus traveling an hour or more to a hospital.

Officials at MedPAC don't want to just cut reimbursement rates. They also want to dictate which drugs doctors should administer to patients.

They would do so by combining billing codes for complex Part B drugs, known as “biologics,” and their therapeutically similar counterparts, known as “biosimilars.” Though the two types of drugs often affect patients the same way, very minor differences can cause some patients to react differently to biosimilars than they do to biologics.

Biosimilars are often less expensive than their reference biologics. Combining billing codes means that doctors may not break even if they choose the more expensive treatment. If a doctor determined that a patient would likely respond better to the original biologic, she'd have to make a difficult choice. Prescribe the biologic—and take a loss on the treatment. Or prescribe the biosimilar—against the best interests of the patient.

Across the country, hundreds of clinics and medical practices are closing. Thousands of critically ill patients are being rejected or redirected to far-away hospitals. Now, MedPAC wants to implement reimbursement cuts that will prevent even more patients from accessing treatments they desperately need.

It's shameful that federal officials are trying to balance their budget by reducing the quality of care available to Wisconsin's million Medicare beneficiaries. Seniors deserve better.

Corinna Silberg is executive director of the Wisconsin Association of Osteopathic Physicians and Surgeons.



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