“We wanted to point out the unintended side effects of these cuts,” said Susanne Johnson-Berns, Georgia chapter president of the alliance, one of six advocates from Cobb who made the Sept. 20 trip.
Johnson-Berns, purchasing manager for Northwest Georgia Oncology Centers, the second largest oncology practice in the state and has a center in Canton, said more than 100 advocates came together to voice their concerns regarding the pending Medicare reimbursement cuts, the annual 2 percent sequestration cuts, the upcoming Medicare Sustainable Growth Rate cuts, and the drug shortages.
“The proposed reimbursement cuts in the 2013 Medicare physician fee schedule are staggering and are counterproductive to maintaining and enhancing a healthy Medicare system,” Johnson-Berns said.
She says that the accumulated payment cuts since 2005 and the flaws that exist with the SGR formula, combined with the 2013 cuts to come, are having a devastating effect.
“It (the SGR formula) rewards overutilization … This system needs to be eliminated because it is not working properly,” Johnson-Berns said. She said that instead of fixing the flawed formula, the payment cuts have been “patched” the last two years, delaying the inevitable task of dealing with the problem. The current “patch” runs out Dec. 31.
Among proposed legislation the group hoped to garner support for is the Medicare Physician Payment Innovation Act of 2012, a bipartisan bill in the House that stabilizes current payment rates, eliminates the SGR cuts, and creates incentives for payment reform. She said both of Georgia’s senators are in support of the legislation, which is currently in committee.
The cuts originated in 2003 with the passage of the Medicare Modernization Act, which created the SGR fee for service reimbursements. Since that time, cuts to physician payments have made automatically each year.
With the combined cuts, Johnson-Berns says they are looking at a 30 percent reduction in their reimbursements. She says their practice is 60 percent Medicare and 40 percent private insurance — which is typical given that most cancer patients are older and are living longer.
She says that in the past four years, 241 community cancer clinics across the U.S. have closed and 392 practices have merged into or become part of hospital systems. She says this has created limited access for Medicaid patients and is increasing costs for everyone.
Following the Washington visit, on Oct. 11, U.S. Sen. Johnny Isakson met with doctors and patients at Northwest Oncology Center’s clinic on Kennestone Hospital Boulevard in Marietta.
Scott Parker, executive director of the center, and Dr. Gould talked to Isakson specifically about the oncology medical home initiative, a growing concept that proponents believe will improve the quality and efficiency of cancer care delivery for all of the stakeholders.
“Sen. Isakson indicated our approach was on target and is what’s needed for meaningful reform,” Parker said. The practice has 224 employees throughout its eight locations and treats 440 people daily.
Dan Long, a 54-year-old Acworth resident who has been battling stage-three rectal cancer for two years, also went to Washington.
“This issue affects everyone,” said Long, noting cancer strikes one in three families.
Long combines a daily chemo pill with chemo maintenance in the form of a portable chemo drip he carries with him. “In my case, I would be in the hospital every other week, and would have been since 2008. With community center oncology, I can still have a functional life.”