The doctors have sent warnings, the Congressional Budget Office has sent warnings, and economists have sent warnings. The question now – is Congress going to listen and reject the Inflation Reduction Act or blame everyone else when the consequences of this horrible bill are exposed?
Last week a new provision was added to the reconciliation process that would reduce payments to physicians that give infusions, a medication that needs to be received through an IV line; like chemo, medications for immunodeficiencies, and chronic diseases; in their offices and hospitals.
Simple right? Well, not so fast. Independent physicians will receive a substantially bigger cut—a larger cut than the physicians employed by large hospital systems that have corporate lobbyists strategically positioned around Washington DC. This new cut for independent physicians will add to the already substantial financial pressure on independent physicians to sell their practices to large hospital systems, further accelerating a trend that has already resulted in 74% of physicians being employed by such entities. Ultimately, it will hit cancer and rheumatology patients hard, as these two kinds of specialists take on substantial financial risk by using a "Buy and Bill" method to give their patients lifesaving and disease-relieving infusions.
The consequences don't stop there – Patient Protection and Affordable Care Act (PPACA) created huge financial incentives for large hospitals to acquire physician practices. But data show that this change has resulted in higher costs for patients without providing any improvement in the quality of care. In fact, one study goes further to recommend that "policymakers should carefully consider policies that limit consolidation of hospitals and physicians." Clearly, the Senate Democrats did not heed this warning. With the payment cuts proposed in the latest bill, hospitals will have greater ability to snap up independent practices.
Some independent groups, like the National Cancer Care Alliance comprised of 200 oncologists, have banded together to share best practices and savings. They state they:
"Have developed systems that are designed to greatly reduce hospitalization rates, avoid hospital facility fees and hospital associated complications, and provide care that is more efficient with better results, and is less disruptive to your life, at a significantly lower cost."
Currently, one in five oncologists are over age of 64. They may simply decide to hang up their practice for good, not wanting to be told how to practice by hospital administrators.
This would be in addition to a 4.4% Medicare pay cut that oncologists face as of January 2023, which is on top of the 4.4% cut they already took this year. Clearly this is terrible timing, as the American Society of Clinical Oncologists estimates a 45% increase in cancer diagnosis by 2030, mostly among seniors and minority populations. Thanks to this policy, Medicare costs will go up and its beneficiaries' access to quality care will decline. As a WSJ editorial notes, "patients will pay a steep price." Both patients and physicians continue to be a casualty of political deal-making in Congress.
Keep in mind the other deleterious effects of this bill. A year ago, the CBO warned that innovation for chronic and currently incurable diseases will decline with the passage of provisions in the Inflation Reduction Act. It is easy to brush this aside until it is you or your loved one that is suffering. It is easy to brush this aside if it isn’t your patient, who may pay with their life. It seems easy for a bunch of elected officials to take these possibilities away from our patients.
It doesn’t necessarily take a game changer to bring relief to our patients. Some new medication innovations can bring comfort. Some might recall that cancer patients treated with anti-nausea medications that barely worked. Ondansetron, now the standard, has been a Godsend.
This bill will be a problem especially for oncology and rheumatology patients. But all of America will pay the inflated prices of further consolidation, reduced access, and less innovation down the road. Congress asked Americans to listen to their doctors during COVID, Doctors are now asking Congress to listen.
Arvind Cavale is a Clinical Endocrinologist in independent practice in Bucks County, PA and a patient advocate.
