U.S. cancer doctors urge payment fix as cases set to rise

WASHINGTON - U.S. cancer doctors are worried about their ability to handle an expected surge in cancer cases in the coming years as they face cuts to government health plans and efforts to reduce payments to physicians.

WASHINGTON - U.S. cancer doctors are worried about their ability to handle an expected surge in cancer cases in the coming years as they face cuts to government health plans and efforts to reduce payments to physicians.

The influential American Society of Clinical Oncology, in a report released on Tuesday, cited estimates that cancer will become the leading killer in the United States by 2030 as the population ages, while treatment costs reach new heights. The group is calling on the U.S. Congress to help stabilize payments to doctors under the Medicare insurance program for the elderly.

"What you are seeing from Medicare as well as others is they continue to constrain the revenues to practices. At the same time, the number of patients everyone is seeing is going up as the population increases," said Blase Polite, an oncologist at the University of Chicago.

"Combine that with the cost of the care that we're providing ... It's really creating a very difficult financial situation," Polite, incoming head of government relations for ASCO, told Reuters.

A projected workforce crunch could also hamper care as demand for cancer treatment rises, ASCO said in the report summarizing its survey of 1,162 oncology practices in 2012 and 2013 representing more than 13,000 physicians. Overall, ASCO represents 35,000 doctors, nurse practitioners, researchers and other cancer care professionals.


Its survey, to be unveiled in a briefing on Capitol Hill later on Tuesday, comes as Congress grapples with how to address looming physician payment cuts ahead of a March 31 deadline.

ASCO and other physician groups have been pressing Congress for years to alter the reimbursement formula known as the sustainable growth rate, or SGR. The U.S. House of Representatives plans to vote on a replacement on Friday.

About 14 million people in the United States have had cancer, and the American Cancer Society estimates that nearly 1.7 million people will be newly diagnosed in 2014 and more than 585,000 will die from it.

By 2030, the rate is expected to jump to 2.3 million new cases each year, ASCO said in its report. The number of those who previously had cancer and survived is also expected to grow.

ASCO President Clifford Hudis said he does not see the group's push taking away from the needs of other specialty physicians and their patients. "All of this crisis-to-crisis management has to come to a stop," Hudis, a breast cancer specialist at Memorial Sloan-Kettering Cancer Center in New York and a professor of medicine at Weill Cornell Medical College, said of Congress's efforts.

Fixing the 'doc fix'

Congress is weighing changes to the physician payment system that calls for sharp cuts in reimbursement to doctors. The system has yet to be put in place because lawmakers have overridden the legislation each year. By the end of March, Congress must either repeal the formula or pass another temporary patch, or "doc fix."

One proposal under consideration would replace the formula with a 0.5 percent annual increase through 2018, then a two-track system with either a 0.5 percent or a 1 percent rise depending on which of the two systems providers use. The Congressional Budget Office has said that measure would increase federal spending by about $138 billion between 2014 and 2024.


Most cancer cases are diagnosed in older Americans, many of whom are covered by Medicare. Other insurers also look to Medicare when setting reimbursement rates to doctors.

The ASCO report estimates a possible shortage of more than 1,487 oncologists by in 2025, in part because cancer providers, like their patients, are aging.

Nearly 14 percent of the U.S. population, or more than 40 million people, is age 65 or older, 2012 data from the Census Bureau show.

Drug costs are also a worry, ASCO's Polite said, as prices have risen to $10,000 a month from $1,000 a month in 1990.

Oncologist Sharon Giordano of MD Anderson Cancer Center in Texas said while the baby boom generation is likely to "put a strain on the healthcare system," there is room for promoting preventive steps such as quitting tobacco use or controlling obesity to help reduce cancer cases, including recurrence.

"Certainly a new diagnosis ... can be really motivating" to make lifestyle changes, said Giordano, who is an ASCO member but was not directly involved with the report. "It's never too late."

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