Hospitals look to legislation to keep outpatient centers open

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Hospitals look to legislation

to keep outpatient centers open

By LIBBY QUAID
Concord Monitor, June 10, 2003

WASHINGTON - Wes Thompson can't think of a better way to remember his wife.

Sarah Wilson Thompson died of lymphoma at the age of 26, and her husband wants to donate money to the outpatient cancer treatment center at the Richmond, Mo., hospital where he works. The trouble is that Ray County Memorial Hospital officials want to close the center because of cuts in federal Medicare payments.

The closure is on hold while Sen. Kit Bond, R-Mo., tries to get Congress to restore some of the money as it considers overhauling Medicare, the nation's health insurance program for the elderly and disabled.

"If we don't give chemotherapy to these patients, 40 percent of them will not be able to get outside of Richmond for cancer care," Thompson said in an interview Tuesday. "I don't know how you live with the thought of knowing there was a possibility of care out there, but you just couldn't get them to it."

The rural hospital treats about 250 cancer patients. Of those, 80 to 100 are too sick or can't afford to make the trip to the nearest oncology center about 45 miles away in Kansas City, Mo., Thompson said. He is director of the hospital's radiation department, a separate unit from oncology.

The problem is not unique to Ray County, Bond said. Medicare reimbursements have plummeted nationwide for hospitals that provide outpatient care for cancer patients. Cuts have been particularly severe in reimbursements for costly cancer treatment drugs, he said.

"Pharmacists are under pressure to review dosing regimens to see where they can cut corners," Bond said in a speech on the Senate floor. "Some drugs are just not being given in these community centers. Others that used to be given free of charge, until their Medicare codes were assigned, now aren't given at all."

Thompson said payments have dropped from about 95 percent to about 64 percent of the actual cost of many chemotherapy drugs. The oncology unit could show net losses of $200,000 to $300,000, down from a net profit last year of $1.32.

Bond is proposing to set minimum payment levels for some of the more costly drugs given in outpatient centers. His legislation would allow hospitals to begin receiving higher payments next January. He hopes to offer the measure as an amendment when a Medicare prescription drug benefit is debated next week on the Senate floor.

There was no immediate reaction to Bond's proposal from the federal Centers for Medicare and Medicaid Services, where a spokesman said more details are needed about which payments the senator is targeting.

Ideally, Bond said, he would prefer a general overhaul of the reimbursement system. But that would take time, the senator said, "and time is one luxury many cancer patients simply do not have."

Time is also running out for Thompson, who said the hospital board agreed to wait on shuttering the cancer center while Thompson approached Bond, and Bond worked to boost payments.

Thompson, 33, had planned to donate money from a settlement in the case of Robert R. Courtney, the pharmacist convicted of diluting chemotherapy drugs in a scheme that may have affected more than 4,000 patients. Sarah Thompson was one of Courtney's victims, her husband said.

He wanted to provide television sets and new carpet and paint the walls a more soothing color than the burnt orange they are now. Patients who look at the 30-year-old decor probably wonder whether the care they're getting is also outdated, Thompson said.

"It wasn't a lot of money, but I wanted to do something that would impact a lot of people in her name," Thompson said. "I work in a hospital that has an outdated oncology department, and I couldn't think of a better way to remember her than by redoing the oncology center here in her name."