Now Doctors are Turning Away Cancer Patients
According to an article in the Washington Post on April 3, 2013, doctors are now turning away cancer patients who can’t pay out of pocket. We previously reported how MD Anderson, a leading cancer hospital in Houston, Texas demanded an upfront payment in cash from Sean Recchi before he would even be admitted to the hospital and about the mind boggling expense of prescription drugs. The patient by the way had health insurance. The admitting agent told him, “We don’t take that kind of discount insurance.” Fortunately, a family member was able to write the check for $83,900. that was demanded before treatment would begin.
Now doctors are doing the same thing – refusing to administer life saving drugs to Medicare cancer patients using the rationale that they they would be losing money because their payments from Medicare are reduced 2% by the sequester. To hear the doctors tell it, they would be put out of business by the smaller payment. However, a little simple math (something that neither the complaining doctors or the writer of the Post article evidently can do) shows that the doctors would still be making money even with the reduced payment. And since they have a ton of other ways to bill patients over and above the bill for the administration of the drug, they still would be making plenty of money. They are just miffed that they wouldn’t be making quite as much money as before so they are taking a page out of the hospitals’ book and demanding payment or at least the difference in payment in cash from the patient upfront before administering the drugs.
“If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year,” said Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates in New York. “The drugs we’re going to lose money on we’re not going to administer right now.”
That’s absolute poppycock and here’s why. Medicare is subject to a 2% reduction under the sequester. Doctors are paid the average of what the pharmaceutical companies charge for the drug which is outrageous in itself but no skin off the doctor’s nose. In addition doctors were paid an additional 6% for storing and administering the drug.
Say a drug cost the doctor $10,000. for one dose (not atypical of today’s prices which can be at least double that amount for some drugs). So the doctor would be paid $10,000. + $600. or $10,600. prior to the sequester. After the sequester the doctor is now being paid 2% or $212. less. So the doctor is paid $10,388. The doctor pays the drug company $10,000. and is left with $388. How is this losing money?
However, Vacirca stated that from now on his clinic would start turning away a third of their patients under the ruse that the more expensive the drug, the more money they would lose. But the simple math above belies that fact. In fact the more expensive the drug, the more money Vacirca’s clinics make for doing the same thing – administering a shot. It costs the doctor no more time or effort to administer an expensive shot than it does to administer a cheap shot. Moreover, the doctor will receive more money from Medicare for the expensive shot than for the cheap shot because he is paid on a percentage of cost basis. Vacirca, however, wants you to believe that the 2% reduction on the price of the drug swallows up the 6% the doctor formerly made. Not so. As the drug gets more expensive, the percentage the doctor gets for administering the drug also increases so that the final result is that the doctor makes more money not less.
The Post reported: “Doctors at the Charleston Cancer Center in South Carolina began informing patients weeks ago that, due to the sequester cuts, they would soon need to seek treatment elsewhere.”
Doctors’ advocacy groups are petitioning Congress to lower the amount that the sequester takes out of their payment. Of course if the Federal government wanted to, it could force the pharmaceutical corporations, Big Pharma, to lower prices or to negotiate prices, something that the Bush administration refused to do when they enacted Medicare Part D drug coverage.
So the doctors who can’t do simple math (or maybe they can but are just trying to pull the wool over Congress’ eyes) are lobbying Congress (who most certainly aren’t capable of doing simple math) to come to their aid and increase the amount they get for administering a dose of a life saving cancer drug. The doctors are saying that the hospitals could possibly take on the patients they are rejecting, but we’ve already seen how hospitals are demanding upfront cash payments from patients so the chances of non-profit (although they make tons of profit) hospitals taking up the slack are about the same as a snowball’s chances in hell.
The cold hard sad fact is that if one is terminally ill and doesn’t have a lot of money then that person might as well make sure their will is up to date. It’s not likely to get any better anytime soon, if at all.
John Lawrence says
If I’m terminal with cancer, I’d rather stock up on morphine so I’m not in pain and turn my assets over to my children before the medical-industrial complex can get their hands on them.
It’s difficult to argue with that. We have allowed capitalism to ruin access to health care.
As a Doctor don’t they have to take an oath or something , like a Hippocratic Oath ? I guess that todays doctors don’t have the perspective anymore to see that life is before money. Its All About The Money And Who Can Afford To Live….. The Drug Companies And Insurance Companies Are Responsible For Most of The Cost Of Medical Costs. There is a cure for Cancer but the Regulators in the FDA and others have Waged a War on the Cures. Most of the Health Issues in the World are caused by the Food We Eat, the Water We Drink, and The Air We Breathe, Which leads me back to my point …. Profit over People is the Evil , The Cancer …..
John Lawrence says
Yes, Alan, the Food Industry and the Medical-Industrial complex are entirely in cahoots. Factory food containing hormones, antibiotics, preservatives, pesticides and herbicides leads to the cancers that the medical industry profits off of. Then the legal industry comes along and sues in behalf (mainly) of the lawyers themselves. It all works together in a very unsavory way. The best we can do is to stay away from fast food, restaurant food and industrial food and eat local farmer produced and organic food, lead a healthy lifestyle, consume fewer calories, exercise and stay away from the doctor’s office and hospitals as much as possible. In other words we need to not lead the American way of life with its consumerist ethic.
bob dorn says
I think it does little good to say doctors are the problem. They’re no more responsible for our health care failure than reporters are for the chosen blindness of Big Media, or soldiers for our murderous warfare. Hospitals and insurance companies are not run by doctors, they’re run by MBAs and legatees with inherited portfolios. It seems to me that we could make common cause with MDs, who are as likely to be as fed up and disgusted by capitalism’s profiteering from death as the rest of us. All but a few doctors I’ve depended upon have been intelligent people of good conscience.
John Lawrence says
Bob, doctors are part of the problem except those few who choose to operate outside the system. They take kickbacks from the pharmaceutical and medical technology companies. They own stock in hospitals, clinics, pharmaceutical corporations and medical technology companies or are owned by them. They are totally in cahoots with the whole system with some exceptions but those are few and far between.
I don’t think you quite understand how It works. The doctor gets average sales price plus 6%. Does this mean the doctor can buy the drug for the average sales price? The simple answer is no, the ASP is calculated from two quarters ago, brand drug prices are always on the rise. By definiton it is the Average, big hospitals can buy for less (volume), regular oncologists buy for more. For Medicare, providing chemotherapy is a break even proposition, and only if the patient pays their copays and payment isn’t denied by Medicare. So any additional cut means the doctor is paying to treat the patient for many of the drugs, it’s just not possible to keep doing that for long and stay In practice. Please do little more research before posting.