ASCO Sequestration Impact Survey: One Month Out, Sequestration Affecting Care of Medicare Cancer Patients

May 9, 2013

Mary Rappaport

ALEXANDRIA, Va.— The results reveal that, while practices are working hard to continue providing care for Medicare patients, many are being forced to send patients to hospitals for chemotherapy and a smaller number are no longer able to see Medicare patients at all. Over time, these changes may radically alter the cancer delivery system in the United States.

More than 500 ASCO members responded to the online survey. While most reported that they are still assessing the full impact of sequestration, many anticipate the need to make even more significant changes in the future. These changes range from reducing patient services and decreasing staff to turning away new A new ASCO survey of U.S. oncology practices shows the automatic two percent budget cut to Medicare chemotherapy drug reimbursement under sequestration is already having a significant impact on care for people with cancer just one month after the federal funding reduction went into effect. Medicare patients and shuttering oncology practices.

“It’s encouraging to see that oncologists are currently doing whatever they can to ensure that their patients receive the critical treatment they need under these funding cuts,” said ASCO President Sandra M. Swain, MD, FACP. “But patient care is clearly being disrupted in some cases, and practices are under great stress. These early findings may just be the tip of the iceberg.”

ASCO Survey Result Highlights

  • 80 percent of survey respondents said that the sequestration cuts have affected their practices:
  • Nearly 50 percent reported not being able to continue caring for Medicare patients unless they have supplemental insurance.
  • 50 percent of respondents reported sending their Medicare patients elsewhere for chemotherapy, primarily to more expensive hospital outpatient infusion centers.
    • Of those respondents sending  Medicare patients elsewhere, the majority of practices reported between 10 percent and 50 percent of their patients were affected by this dislocation. However, some have had to redirect all of their patients.
    • 25 percent reported no longer participating in clinical research.
    • 14 percent reported having to stop taking Medicare patients altogether at the time of this survey.
      • 74 percent of survey respondents reported having difficulty paying for chemotherapy drugs.
      • 22 percent reported they have or will need to close satellite clinical or outreach clinics, assuming the sequester cuts remain in place.

Other Survey Findings:

  • Sequestration is also beginning to have an impact on patients covered by Medicare Advantage plans, with 27 percent of responding practices reporting that they will no longer take these patients.
  • Although a range was reported, Medicare fee-for-service patients commonly comprise approximately 50 percent of a practice’s new patients in a year; if a sizable percentage of these patients are sent to hospital outpatient departments for chemotherapy, real capacity issues for these centers could result.

Disruption of Chemotherapy Services a Major Burden for Patients

The diversion of patients to hospitals or other facilities for chemotherapy could have a major impact on patients. ASCO is concerned that, in many areas of the country, this change will require significant travel or administrative burdens for patients who are already struggling with the activities of daily living and the side effects of life-sustaining drugs.

“Sequestration is not just a trivial matter of inconvenience to patients who may be referred to other treatment facilities to receive their chemotherapy,” said ASCO President Sandra Swain. “Cancer patients are very sick, often elderly, and may struggle with great fatigue and discomfort. Having to travel just an additional 10 miles and be treated in a larger system can be a traumatic experience for these patients.”

Survey Background

The ASCO sequestration impact survey was conducted April 23 – May 1, 2013 as Medicare began processing reimbursement claims under the funding cuts, which became effective April 1, 2013.  Survey results reflect a wide demographic mix of oncology practices with 44 percent in suburban settings, 41 percent in urban settings, and 16 percent in rural settings. Responding oncology practice ranged in size from 1 to 48 full-time medical oncologists.

Because sequestration’s impact is in its earliest phase, ASCO will re-survey its membership in the coming months to monitor the effect of the funding cuts over time.

Congressional Activity

ASCO is advocating for the repeal of sequestration and strongly supports The Cancer Patient Protect Act of 2013 (H.R. 1416), introduced by Representative Renee Ellmers (R-NC) and currently co-sponsored by 64 Members of Congress. The bill would exempt Part B drugs, including cancer and supportive care drugs, from the 2% sequestration cut.

About ASCO
The American Society of Clinical Oncology (ASCO) is the world’s leading professional organization representing physicians who care for people with cancer. With more than 30,000 members, ASCO is committed to improving cancer care through scientific meetings, educational programs and peer-reviewed journals. ASCO is supported by its affiliate organization, the Conquer Cancer Foundation, which funds ground-breaking research and programs that make a tangible difference in the lives of people with cancer. For ASCO information and resources, visit Patient-oriented cancer information is available at