June 4, 2015—The trend in cancer care away from physician offices toward hospital settings has little to do with the 340B program, and restricting 340B to alleviate the shift would only hurt vulnerable patients, two nationally prominent oncologists write in the Journal of Oncology Practice. [ms-protect-content id=”2799″]
The co-authors are Dr. Hagop Kantarjian, professor and chair of leukemia at the University of Texas MD Anderson Cancer Center in Houston, and Dr. Robert Chapman, director of the Josephine Ford Cancer Institute at Henry Ford Health System in Detroit. Chapman’s institution is in the 340B program but Kantarjian’s is not. The medical journal published their article online on June 2 (subscription or purchase required) in advance of its appearance in the July 2015 print edition.
Research claiming that access to 340B discounts drives hospitals to buy private oncology practices fails to take into account bigger long-term trends, the two physicians note. “In fact, all hospitals are purchasing oncology practices regardless of their 340B status,” they write. “The shrinking profits in oncology practices and incentives and financial securities associated with hospital settings have encouraged this shift.” Likewise, the argument that the growing number of hospitals in 340B is behind the shift in cancer care also lacks merit, Kantarjian and Chapman continue. Nearly all such growth is due to small rural hospitals joining and they account for just 3 percent of 340B drug sales, the authors say.
Kantarjian and Chapman attribute the trend toward hospital care mainly to “declining profits and revenues in private oncology practices as a result of the Medicare Modernization Act of 2003 and the average sales price plus 6% reimbursement rule.” It and other financial pressures “result in hospital-affiliated practices becoming financially safer environments,” they say. The other factors they cite include declining reimbursement rates for visits and procedures; financial pressures and payment models that do not consider the complexities involved delivering care in an office setting; and increased practice expenses for electronic medical records systems, information technology, billing documentation, and regulatory compliance.
“Attributing the shift in cancer care to 340B and restricting 340B would not address the major causes of this shift and would adversely affect vulnerable patients currently helped by safety-net providers,” Kantarjian and Chapman write.
They offered possible alternative solutions including:
- Letting private oncology practices qualify for 340B if they agree to shoulder the same burden of care for vulnerable patients as hospitals in the drug discount program. In practical terms, this would mean that roughly 30 percent of their patient load would have to qualify for Medicaid or Medicare Supplementary Security Income payments. Elsewhere in the paper, Kantarjian and Chapman note that, in 2012, only 4 percent of patients treated by community oncologists were uninsured and only 4 percent were covered by Medicaid.
- Modifying the reimbursement formula for delivering cancer chemotherapy in the doctor’s office “to account for the complexities of care.”
- Offering U.S. citizenship to “outstanding” foreign medical students who complete oncology training in the United States and agree to practice in underserved areas for extended periods.
- Moving away from fee-for-service reimbursement and towards bundled care.[/ms-protect-content]