02/15/10 — Local doctors share concerns over cuts

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Local doctors share concerns over cuts

By Steve Herring
Published in News on February 15, 2010 1:46 PM

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State Sen. Don Davis, left, listens as Bo Gamble of the Southeastern Medical Oncology Center Goldsboro office talks about how state Medicaid reimbursement cuts have disrupted lives and have actually resulted in higher costs. Davis was at the center Friday for a videoconference call with oncology practices from across the state. In the background at right, another participant is on the monitor screen.

State cuts in Medicaid reimbursements for cancer drugs might be helping reduce the budget deficit, but they are creating great hardships for those people battling the disease while at the same time driving Medicaid costs higher, physicians told state Sen. Don Davis during a videoconference Friday.

Davis took part in the conference at Southeastern Medical Oncology Center. Four other medical practices across the state that deal with cancer patients also participated.

The doctors urged Davis to take the message back to Raleigh with him when the legislature returns to session.

They also want his help in removing a restriction that prohibits physicians' offices from dispensing oral medicine/chemotherapy drugs.

Davis was the only state legislator to respond to a mass e-mail sent by the practices to lawmakers. He told those involved in the conference that he would relay their message to his fellow legislators and suggested that staff at the cancer centers meet in Raleigh, possibly as early as Feb. 23, with Sen. William Purcell, D-Scotland, a retired pediatrician who is co-chairman of the Health Care Committee and of Appropriations on Health and Human Services.

SMOC founder Dr. James Atkins, who took part in the conference call from the practice's Clinton office, said that in the past when a certain drug was given that the practice might have made $20.

"But once October came around for me to give that patient the treatment I was going to have to take $200 for each treatment out of my pocket and give it to the state because they gave us $200 less," Atkins explained.

He cited as an example one of his patients who lives in Clinton and who will now have to drive 45 minutes to Goldsboro to be treated at the hospital since the practice cannot afford to subsidize the drug cost.

"She is already on Medicaid so she doesn't have a lot of money, doesn't have gas money, but she is having to drive all of the way to Goldsboro and back for eight more treatments," Atkins said. "So she was burdened not only with the inconvenience of an hour and a half drive, 45 minutes both ways, but the inconvenience of being in a hospital setting probably adds another two to three hours to any kind of treatment.

"The family now has to take time off of work to drive her all the way to Goldsboro and then it is going to cost the state in the neighborhood of 20 to 30 percent more than what it would cost in an office practice."

Atkins said another patient needed to start drug treatment, but his office could not dispense it. The patient was given a prescription and hopefully the pharmacy will have it by Tuesday or Wednesday, resulting in a delay in starting the treatment, he said.

There is even a question of whether Medicaid will allow him to treat her with the drug, Atkins added.

"We are typically priced less than the retail pharmacies," said Bo Gamble of the SMOC Goldsboro office. "We follow the patient better. We know the patient better. We educate the patients better than they (pharmacies) do on their cancer-related issues. That is a long standing issue and we do not know why it is that way."

Just as importantly is the bond that develops between the patients and center staffs, he said.

Gamble told Davis the staff hears stories of patients who feel like they are getting substandard care.

"They are made to feel inferior because where we can do something very efficiently -- we are very mobile and treatment may take three to four hours -- it may take 8-12 hours in the hospital and consumes their whole day. Some folks are saying, 'I refuse' just because they (hospital) are not designed to provide efficient cancer care like we are in the community," Gamble said.

Davis heard similar stories from staff members in the other offices concerning the bond between patients and the staff at the cancer centers and how those patients have been disrupted by having to be sent to a hospital for treatment.

The four other practices involved in the conference call were Gaston Hematology Oncology in Gastonia, Cancer Care of Western North Carolina in Asheville, Lake Norman Hematology Oncology in Mooresville and Oncology Specialists of Charlotte.

"We are not trying to make money on the drugs. But we cannot afford it and we are in some instances paying the state to take care of the patients," Gamble told Davis. "We are in the hole for hundreds of dollars for people coming in the door. Some of the drugs are very expensive. What we look at it and if can't at least cover our cost, we send them to the hospital where Medicaid is going to end up spending more money. If we are covering our cost we will treat them here."

SMOC is a large practice with four offices and sees 170 patients a day and spends $1.2 million a month on drugs, he said.

Gamble told Davis that based on information provided by the North Carolina Medical Society, Medicaid pays an average of 23 to 30 percent more to hospitals for the same drugs and services provided in the office.

"We provide chemotherapy in this office. They (the state) lowered the reimbursements to use that we can't even afford to take care of these patients. Our drugs cost us more than they (Medicaid) are paying us. Basically when a Medicaid patient walks in the door we are paying the state to try and take care of these people. It is not on every treatment, but it is on a large portion of treatments.

"What that has done, the patients need care, so it has sort forced our hand and we send them to the hospital for treatment. That does two things -- it costs the Medicaid program more money which they thought they were saving money by cutting the reimbursements to us. But it is costing more because it costs more in the hospital."

The change that went into effect in October "blindsided" cancer-care centers across the entire state, he said.

"We sent out a mass of e-mails to our representatives saying are you sure? This is not healthy for your Medicaid population," Gamble said.

There are actually two components to treatment costs at a hospital, he explained. Not only is the drug more costly, the visit results in a need for more office visits which also add to the cost. The additional follow-up office visits are required because the patients are at the hospital and not with their doctors at the center at the time of the treatment.

Gamble told Davis that the practices recognize the budgetary constraints and are willing to work within them.

Davis said he was glad to hear the practices understood the economic conditions. He called the cuts made in health and human services programs "tremendous."

He said he was his understanding that more support for Medicaid would be sought during the upcoming legislative short session.

He reminded them that the state had been able to use federal stimulus money to help balance the budget. However, those funds were one-time and will not be available again.

"The major things I see taking on in the short session ... the governor has said reversions that equate to about $500 million for the fiscal year. Then she looked at the revenues. We are running about 4 percent short in terms of overall collections. We were about $90 million in the hole in November and now it is over $240 million in the hole," Davis said.

Davis said the state Department of Revenue had projected $150 million in extra funds, but that could be closer to $400 million basically resolving the shortfall.

"I would be surprised if the General Assembly did not look at those one-time revenues and try to relieve the situation with Medicaid," he said. "The problem in that scenario is that it is one-time revenue that goes away. On top of that the stimulus dollars go away in 2011. On top of that we have the temporary sales tax. I am saying that to say that by no means are we out of this.

"I will take your concern back and look deeper into the background needs."