By Sue Roy
Live long and prosper! Buckeyes are taking Spock’s famous advice to heart. Over the past three decades, Ohioans’ life expectancies have increased in every county.
They can thank healthcare programs like Medicare Part B for these increases in longevity. Part B helps seniors pay for lifesaving medicines, such as chemotherapy, that must be administered by healthcare professionals. Unfortunately, the federal government may soon change the program and restrict Ohio seniors’ access to these drugs.
Doctors pay for Part B drugs up front. The federal government then reimburses doctors the average cost of treatment plus a small add-on fee for administrative costs.
In April, the Medicare Payment Advisory Commission — an independent federal panel more commonly known as MedPAC — recommended reducing the add-on fee from 6 percent to 3 percent.
These cuts could put providers, especially those in rural areas, out of business. Sixty-nine percent of rural hospitals already operate at a loss. Experts predict that 25 percent of rural hospitals will close in the next ten years due to financial constraints.
Ohio is no exception. Two rural hospitals have already closed in the state. Additionally, 16 clinics have shut down, while another eight are struggling to stay open.
If reimbursement cuts don’t cause these facilities to shut down, many might still need to turn away Part B beneficiaries to avoid losing money. Patients in rural areas would have to travel further to receive care in big hospitals that can afford to operate despite razor-thin reimbursement margins.
Such travel is more than a mere hassle — patients undergoing Part B treatments for rheumatoid arthritis, for instance, often receive infusions once every 15 days. These infusions can take four hours to administer. Sick patients may not have rides or enough money to travel hours from their homes to receive these treatments. As a result, many patients might just opt out of treatment, grow sicker, and increase healthcare costs in the long-run.
MedPAC also recommended combining Medicare billing codes for highly advanced “biologic” drugs and the “biosimilar” medicines that closely, but not perfectly, mimic them.
In practice, setting a single billing code — and therefore, a single reimbursement rate — for different medicines would force most doctors to switch their patients to cheaper biosimilars, since the reimbursement would no longer cover the full cost of biologic drugs.
Patients who transition from biologics to biosimilars can experience adverse reactions. One study published in the Annals of the Rheumatic Diseases examined rheumatoid arthritis patients who stayed on a biologic for two years versus those who transitioned from a biologic to a biosimilar. It found that 46 percent more of the transitioning patients experienced adverse side effects compared to those who did not make the switch.
Doctors shouldn’t be forced to put their offices’ financial wellbeing ahead of their patients’ physical health.
Medicare Part B has helped extend and improve Ohioans’ lives. Slashing reimbursements would reduce access to care by causing clinic and hospital closures. And forcing doctors to switch patients off successful treatment regimens would harm patients’ health. Both moves, in the words of Spock, would be “highly illogical.”
Sue Roy is the legislative director for Ohio State Grange