Tester's defense of Montana seniors deserves applause

by Gregory Smith

President Obama’s 2016 budget could jeopardize retirees’ access to medical care by cutting Medicare reimbursement rates for drugs administered under physician supervision, drugs used to treat serious diseases such as cancer and rheumatoid arthritis.

Luckily, U.S. Sen. Jon Tester is leading the charge to protect seniors from these cuts. His fellow lawmakers should join him in defending Medicare Part B.

For many Medicare patients, routine doctor visits are a way of life. Particularly for patients with cancer undergoing chemotherapy or for patients with other conditions that require treatments that can only be administered under physician supervision. Under the Part B program, physicians buy the drugs for these services up front, bill Medicare for the costs after they administer the drugs to patients, and are then reimbursed. Part B has already faced reimbursement cuts in recent years, and more may be coming.

Cuts to Part B reimbursement rates for drugs especially effect Montanans due to the state’s geography – many people live hours from a full-service hospital and depend on independent physician groups and clinics. Reimbursement cuts put the squeeze on these small providers, which have higher costs and lower purchasing power compared to larger organizations.

Around the country, hundreds of clinics and doctors’ offices are closing or being consolidated into hospital groups as providers struggle to make ends meet in the wake of Medicare reimbursement cuts. Hospital acquisitions of clinics generally increase the cost of care to patients and the government, and the closing of clinics forces patients to drive even farther to receive timely care.

Such reimbursement cuts have hit Montana particularly hard. In recent years, five oncology clinics in Montana have been acquired by hospitals and three others report they are “struggling financially.”

And the circumstances could get worse, as the budget-cutting policy of sequestration, or across-the-board Medicare payments cuts of 2 percent, has been in effect in recent years and is scheduled to continue for the next decade.

President Obama’s proposed fiscal 2016 budget would add to small healthcare providers’ burden by chopping reimbursement rates on Part B medications from 106 percent of a drug’s average sales price to 103 percent. This might seem like a small change, but the current 6 percent add-on is supposed to cover overhead, shipping, and other costs. Because rural clinics have higher than average costs, the add-on already offers little padding.

Thankfully, Tester is pushing back against such reimbursement cuts to Medicare Part B drugs. Earlier this year, he helped pass the “doc fix,” a bill which averted a 21 percent cut in physicians’ Part B reimbursements. Such steep cuts would have forced many doctors to stop treating Medicare patients.

Constituents are taking note. My own organization, Montana AIDS Outreach, has commended Tester “for leading the fight” to protect Medicare Part B.

Tester explains his efforts to ensure that “health providers get fair reimbursement for caring for seniors on Medicare” as a way to guarantee “seniors continue to access quality care close to home.”

That should be the goal of lawmakers across the nation. To accomplish it, they ought to start voting more like Montana’s senior senator.

Gregory Smith is the former executive director of Bozeman-based AIDS Outreach.