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Bureaucrats vs. Cancer Patients


David Eagle, MD

Last summer the nation was shocked when former President Jimmy Carter announced he had been diagnosed with cancer that had spread to his brain. Then, just over four months later came another shock when he announced that a groundbreaking immunotherapy regimen that had, miraculously, put his cancer into remission.

There are stories like President Carter's across our state and nation of thousands of desperately ill patients facing cancer who turn to cutting-edge alternatives and have their lives saved.

Access to such cutting-edge treatments is now in jeopardy. Federal officials recently announced a mandatory Medicare "experiment" that will make it much harder for North Carolina's most vulnerable patients to receive life-saving medications.

Government bureaucrats at the Centers for Medicare & Medicaid Services (CMS) are targeting Medicare Part B, which covers drugs that have to be administered under a doctor's supervision, such as those for cancer, cerebral palsy, and immune deficiency disorders. Doctors who treat Part B patients pay for these services directly and then bill Medicare for reimbursement.

Part B plays a crucial role in the lives of the 1.7million North Carolina's currently enrolled in Medicare. For many, it's the only way they can afford the drugs that keep them from dying - and the recently announced CMS experiment will jeopardize their care by making it much harder for physicians to provide treatment.

First, officials are ratcheting back physician reimbursements in the experiment, cutting the way they pay doctors in Medicare by about two thirds. Many doctors have already opted out of Part B because it pays so little. The existing way it is paid for by the government is simply financial untenable: many doctors lose money on every enrollee they treat. In fact, some community oncologists already send their Part B cancer patients to hospitals to receive chemotherapy because they can't afford to administer it in-house.

Further reimbursement cuts will prompt even more doctors to abandon the program, and Part B patients will have an even harder time finding someone to treat them.

Next, the experiment will install what it calls a "value-based care" model that pushes physicians to prescribe cheaper treatments. This will discourage them from using the newer, more advanced drugs such as those that helped President Carter. Whose "value" the government will be used to determine if or if not patients can receive drugs is still not clear, but we are being asked to trust the bureaucrats that they know and will get things right.

What is most insulting is that this experiment represents a profound intrusion of the government into the doctor-patient relationship. Medicare officials are saying doctors don't know what is best for their patients. And if this experiment becomes reality, the government could effectively dictate what treatments we choose based on cost, not what's best for our patients.

If CMS gets its way with this experiment, there is a very real possibility that desperately ill North Carolina patients who aren't lucky enough to be a former President of the United States could be denied the moonshot treatments that save lives. This experiment is the absolutely worst thing we could do to our nation's fight against cancer.

David Eagle is a practicing medical oncologist with Lake Norman Oncology in Mooresville.

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