Congress: Keep community oncology within reach for cancer patients

Mark Fleming, MD :©US Oncology Network

Each year, millions of cancer patients look to community oncologists to help treat their disease so they can live longer, healthier, and more fulfilling lives.

Across the country, community-based cancer centers help assure patient access to cost-effective, high-quality treatment options. Our mission as independent oncologists is to provide hope and support during a time of uncertainty and stress – close to home. We take this mission seriously.

However, misguided Medicare policies make it more difficult for independent cancer specialists to deliver patient care, especially in the community setting. As the cost of providing care has surged, Medicare payments to physicians have precipitously declined, threatening independent practices’ ability to keep their doors open to seniors with cancer.

The Centers for Medicare & Medicaid Services recently finalized yet another serious cut to physician payments. These cuts have an outsized impact on cancer patients, as over half are enrolled in Medicare. Dwindling payment rates, rapidly rising expenses, and increased administrative burden are leading many independent physicians, including oncologists, to merge with hospitals or shut down altogether.

At the same time, hospitals continue to receive higher reimbursement rates, access to 340B discounts, and generous tax benefits, grants, and earmarks. 2025 is no exception: while Medicare is set to cut payments to independent physicians by 2.8% next year, it is increasing payments to hospital-affiliated physicians by 2.9%.

This uneven playing field is leaving many physicians with no other choice but to sell their practice to larger hospitals and health systems. The long-standing disparity between hospital and physician reimbursement has fueled hospital acquisitions of private practices, particularly in cancer care. From 2008 to 2020, over 1,000 community oncology practices closed or were acquired by hospitals, where patients end up paying nearly three times more for services like chemotherapy.It’s no wonder, then, that patients are finding community-based care harder and harder to find.

The loss of independent practices is troubling for physicians and patients. In private practice, physicians can spend more time with patients and make decisions that are best for the patient, not just for the bottom line. On the other hand, many physicians report a loss of autonomy in the hospital setting.

As this trend of consolidation continues, patients are paying higher prices for more fragmented care. Multiple studies show that consolidation actually increases prices both in Medicare and the commercial market, as a more concentrated market share increases hospitals’ negotiating power.

Meanwhile, consolidation gives hospitals the power to tack on so-called “facility fees” – charges patients face for simply visiting a clinic that is owned by a hospital or large health system. These fees can cost thousands of dollars and often come as a surprise to patients, who may not have even stepped foot on a hospital campus.

Consolidation deprives patients of the power to choose care in a more cost-effective setting closer to home. If community-based oncologists are going to keep their doors open, lawmakers must do three things to ensure that community-based care remains an option for patients:

To stop the bleeding, Congress must first stop the latest proposed 2.8% cut to physician payment from going into effect in 2025. The recently introduced Medicare Patient Access and Practice Stabilization Act(H.R. 10073) would do just that. The bipartisan bill also includes a modest, positive update, providing much-needed relief to independent providers that are struggling to remain operational due to higher costs and lower payment rates.

• Beyond this year’s cut, Congress must also pass long-term reform that includes inflation-based payment updates under the Medicare Physician Fee Schedule. This would allow physicians, no matter their specialty, to receive payment that more accurately reflects the impact of rising practice costs and help them keep their doors open.
• Finally, lawmakers must equalize payment across care settings through the Lower Costs, More Transparency Act(H.R. 5378) or the recently introduced Cassidy-Hassan framework. Doing so would enable true competition between private practices and hospitals, lower costs, and improve care options for patients.

Unless Congress takes swift action, years of successive Medicare payment cuts and an uneven playing field for independent physicians will undermine access to community cancer care for millions of at-risk cancer patients nationwide. It’s up to lawmakers to ensure that this worst-case scenario does not happen.

Mark T. Fleming, M.D., is a community oncologist and Chair of The US Oncology Network’s National Policy Board.