News impacting community cancer care
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July 6, 2023

The US Oncology Network Applauds Reintroduction of the Medicare Patient Access to Cancer Treatment Act

Cancer Care Leader Urges Lawmakers to Support Bill to Improve Access to Affordable Cancer Care

WOODLANDS, Texas, July 6, 2023 —The US Oncology Network – one of the nation’s largest networks of independent, community-based oncology practices dedicated to delivering high-quality, integrated cancer care – today applauded Representatives Jodey Arrington (TX-19), Debbie Lesko (AZ-08), and Michael Burgess, M.D. (TX-26) for reintroducing the Medicare Patient Access to Cancer Treatment Act which would establish a more equitable reimbursement structure for cancer care delivered in the community setting.

“Site of service payment differentials that favor large health systems over independent physician practices are driving consolidation and harming the financial stability of smaller practices, a trend that is especially pronounced in oncology,” said Marcus Neubauer, M.D., Chief Medical Officer, The US Oncology Network. “This bill recognizes the critical need to address this issue and is specifically tailored to tackle the unique challenges that community cancer care faces today.”

Payment disparities between community-based oncology centers and hospital outpatient departments (HOPDs) for cancer services have grown significantly over the past decade. When examining reimbursement rates for commonly used services in a typical oncology practice, payment for drug administration services is approximately 164 percent higher in the HOPD setting and payment for radiation therapy services is nearly 50 percent higher in the HOPD. This has contributed to a shift in cancer care delivery from the physician office setting to higher-cost hospital settings and incentivized consolidation. From 2008 to 2020, over 1,000 community oncology practices closed or were acquired by hospitals, reducing patients’ access to their trusted health care providers and driving up health care costs for patients and the Medicare program.

Congress attempted to address this discrepancy in the Balanced Budget Act (BBA) of 2015 by applying site neutral payment rates to new HOPDs. According to MedPAC, however, this provision has been ineffective because the majority of HOPDs continue to receive the old, higher payments under the BBA’s grandfathering clause. As a result, extending site neutral payments to additional services or additional locations is a policy concept that has received support from Medicare experts and patient advocates on both sides of the aisle. The Network is pleased this legislation will build on bipartisan legislation that has already passed the House Energy and Commerce Committee to expand site neutral payments.

“The Medicare Patient Access to Cancer Treatment Act is a comprehensive legislative solution that will reduce out-of-pocket costs for cancer patients, lower Medicare spending, and increase patient access to high-quality cancer care in the community setting,” said Debra Patt, M.D., Ph.D., MBA, Chair of the Public Policy and Reimbursement Committee for The US Oncology Network National Policy Board. “We commend Representatives Arrington, Lesko, and Burgess for their leadership and look forward to working together to build support for this valuable Medicare policy.”

The Medicare Patient Access to Cancer Treatment Act was previously introduced in the 114th Congress.