Network News

Network advocates visit with lawmakers to educate them on the issues impacting their patients and practices.
June 14, 2024

Dr. Ralph Heaven Pens Op-Ed on Need for Site Neutral Payments in Cancer Care

Dr. Ralph Heaven, MD, a hematologist-oncologists at Texas Oncology in Abilene, published an op-ed in the Dallas Morning News sharing his insight on how site neutral payments are contributing to health care consolidation, driving up costs, and restricting patient access to community cancer care.

Dr. Heaven highlighted the growing payment disparity between independent practices and hospital outpatient departments (HOPDs) and how this is leading hospitals to acquire community-based providers and charge higher prices. “In 2016, the first hour of chemotherapy infusion – one of the most common services billed by oncology practices – was reimbursed at $136 for physician’s offices, while payment for hospital outpatient departments was 106% higher, at $280, according to the Centers for Medicare and Medicaid Services. This year, that payment disparity has jumped to 158% with physician reimbursement declining to $129 and the outpatient department rate increasing to $333. This means that today, chemotherapy is nearly three times more expensive when provided in the HOPD setting,” Dr. Heaven wrote.

This has resulted in hefty price tags for patients, whose out-of-pocket costs increase dramatically when care is provided in the more expensive hospital setting. Dr. Heaven emphasized that hospital acquisition of independent cancer centers is restricting access to care for rural patients, particularly in Texas. Community cancer practices often operate satellite sites that bring oncology services directly to rural areas. However, these are often the first to close when community oncology practices are bought by hospitals as they are seen as unprofitable. This results in rural patients being left without access to their trusted oncology providers.

This op-ed is timely as the Abilene area is represented by Congressman Jodey Arrington (TX-19) who recently introduced the Medicare Patient Access to Cancer Treatment Act (H.R. 4473), along with representatives Debbie Lesko (AZ-08), and Michael Burgess, MD (TX-26). Dr. Heaven urged federal lawmakers to support this bill as it would equalize reimbursement for cancer services across the hospital outpatient department and physician office setting.

To read Dr. Ralph Heaven’s op-ed in the Dallas Morning NewsCLICK HERE.

To read the full text of the Medicare Patient Access to Cancer Treatment Act, CLICK HERE.