ASCO Alarmed about Medicare Payment Data Release

Statement by the American Society of Clinical Oncology

April 9, 2014

Mary Rappaport 571-483-1374

The American Society of Clinical Oncology (ASCO) is deeply concerned about today’s release of Medicare physician payment data. ASCO is committed to the delivery of high quality, high value care for all people with cancer in the United States. This data release solely focuses attention on the dollars paid to practices for the medical care and treatment of patients on Medicare, rather than contributing to the ongoing national conversation about value and quality in health care.

While ASCO strongly supports transparency in health care and sharing information with patients, the data released by Medicare today was issued with no context or explanation about the complexity of the payment system, the value of the services provided, and the needs of patients with cancer. The Medicare release makes healthcare delivery less transparent than it initially may seem. Compounding this situation are the extensive inaccuracies in the data for many oncologists throughout the United States.

Cancer care is unique among specialties in the way it is reimbursed by Medicare. Oncology practices must purchase very expensive chemotherapy drugs for their patients prior to receiving reimbursement for those drugs from Medicare. Cancer patients also have life-threatening illnesses that require extensive patient services, many of which are under-reimbursed or not reimbursed at all by Medicare.

Most of the amounts shown in the Medicare database for oncologists are not, in fact, revenue to oncology practices. Instead, these Medicare payments merely cover the upfront costs of purchasing drugs for patients. Also, the data reflect the high cost of some chemotherapy drugs which further distort the actual practice revenue. A substantial proportion of Medicare reimbursement also goes to providing the highly skilled professional staff necessary to care for seriously ill patients, such as oncology certified nurses and pharmacists.

We urge the Centers for Medicare and Medicaid Services (CMS) to work with ASCO and the oncology community to identify and correct data mistakes and to refrain from releasing more information until a more helpful process can be established that provides reimbursement information in the appropriate clinical context. We further ask CMS to allow physicians to review their personal information for accuracy—something not currently permitted.

ASCO is actively engaged in helping physicians make the best clinical decisions with and for their patients by disseminating clinical guidelines, establishing quality measurement and improvement programs, and fostering open discussions about cost and value.  We look forward to working with CMS to advance our common goals by ensuring that this information is useful and meaningful to physicians and patients.

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