Number 6
Autumn 2006
We have been deeply disturbed by recent reports concerning the cost of cancer drugs and the role of the medical oncologist in delivering them to patients. One such report was aired on NBC Nightly News on Thursday, September 21. This report, entitled "Cancer Docs Profit From Chemotherapy Drugs: Situation Begs the Ethical Question: Are They Over-Prescribing?" fundamentally misrepresented the facts. Our physicians have been disturbed by reports like the one broadcast by NBC because of the implication that they care more about profits than about their patients. As one of our physicians wrote to NBC about the reporters who worked on the story, "They were provided with accurate data on how reimbursement takes place and how the new payment system works. They were informed of the high drug cost and were provided with a detailed description on the shortfalls of the current system. Despite all the information provided, the story was biased, factually inaccurate, and certainly provided no balance."
NBC Nightly News reported, "Doctors in other specialties simply write prescriptions. But oncologists make most of their income by buying drugs wholesale and selling them to patients at marked-up prices." The implication that we are making big profits on drugs is simply false. Here are the facts.
The purchase and dispensing of prescription drugs in the U.S. is controlled by two separate forces.
In cancer treatment, Medicare is by far the biggest payer, so the majority of all the drugs that are delivered to oncology patients are reimbursed based on this "ASP + 6%" formula. And Medicare policies quickly spread to private insurance companies and other payers. Some of them pay, say, Average Sales Price plus 10%, or plus 20%, but the Average Sales Price is the benchmark.
Medicare pays only 80% of what it "allows;" as is the case with most insurers, the patient is required to make a "co-payment" to cover the other 20%.
To Serve You Better A Newsletter for the Patients of Oncology Specialists, S.C.
Number 5 Summer, 2006
On Thursday, July 27, our Park Ridge office will close at noon. On Monday, July 31, it will reopen on the second floor of the renamed Lutheran General Center for Advanced Care. This relocation from our main floor space to a completely redesigned facility one floor up will be a big change for us and for our patients.
To start with, patients will be able to enter directly from the parking garage recently constructed just north of the Cancer Center. Our space will be our own, enclosed and self-contained. Our chemotherapy, lab, pharmacy, and physician spaces will be in close proximity to one another just inside our new reception room.
Improvements will include a kitchen for our treatment patients with space to store lunches and fix your own snacks without feeling you’re “in the way” of a busy corridor. We will have newly-designed chemotherapy spaces, almost all of them with windows. A special injection room will make it more convenient for patients to stop in for their shots.
Here are some changes you will see:
Parking. The new 500-car garage next door to our building should make it much easier for self-parking. It’s not free, but it’s reasonably priced. We hope you’ll try the garage, and when you do, try parking on the second floor so that you can walk directly into our new space.
Valet Service. This service will continue to be available for a fee in the driveway off Luther Lane at the front of the building.
Patients under active chemotherapy treatment should consider a reduced-price parking sticker from the hospital’s security service. Information about this will be available soon.
Moving from place to place. Our new space is designed more like a traditional doctor’s office. Patients who have their blood drawn will return to the front desk, rather than going directly to an appointment for chemotherapy or a doctor visit. One visitor will be allowed to accompany patients for appointments. Everyone, patients and family members alike, must be escorted into our clinical areas and will be asked to wear an identifying tag.
We think you will find the new space more convenient and less confusing. We have worked hard to design new procedures to help our patients get where they’re going and to serve them with efficiency and comfort. We appreciate your patience as we change our workflow and implement some new processes that will provide more efficient service.
We look forward to your feedback about our new Park Ridge space. And we really appreciate your patience during these months of construction!
Here’s a simple piece of advice: if you are being treated for cancer, or some other chronic condition, be careful about changing your insurance coverage. Before you enroll in a new plan, check with your physician to find out if your treatment can continue. Under the rules of HIPAA (Health Insurance Portability and Accountability Act), you cannot be denied coverage for a pre-existing condition. But you can be denied coverage for a particular treatment or drug that you are now receiving that is not covered at all by your new plan.
So think about this carefully before you decide to save a few dollars on premiums or change your deductible. Changing plans means changing benefits.
There’s another reason that patients should be very cautious when considering health insurance coverage these days.
Medicare changes have been everywhere in the news the past couple of years. At the same time, the cost of drugs and tests such as CT scans, MRIs, and other sophisticated procedures continue to increase. So there has been a barrage of advertising by large health insurers offering new plans and types of coverage.
Of particular interest to many of our patients are plans in which Medicare beneficiaries are enrolled by private companies. The insurer seems to promise more benefits than the patient could enjoy if he just stayed with Medicare.
Ask yourself, “How is this possible?” Medicare is the most efficient payer in the country; its administrative expenses are much lower, as a percent of benefits paid, than any private company. So how can a company be profitable –after all, they’re all traded on the stock market—by taking Medicare’s money and using it to provide more benefits than Medicare does?
Of course, it can’t. So there must be something else going on.
Usually, what’s going on is that benefits for chronic illness are not as good and not as assured as Medicare's benefits.
If you have normal health care costs, these plans may actually be okay. But when costs escalate for chronic conditions such as cancer, patients may find that they are responsible for very large co-pays, that there is a ceiling on their benefits, or, worst of all, that their treatment simply won’t be covered.
The cost of physician care, that is, the doctor’s fee, has actually grown very little in recent years. Many insurance plans, including Medicare, pay physicians less for an office visit than they did five years ago. This is not where the huge increases in health care costs have come from.
So if your current insurance is paying for your treatment, be skeptical of offers to change coverage. Things that seem to good to be true, remember, are usually not so good or not so true.
Look us up on our new web site: www.oncmed.net. We hope you find it useful and informative.
Ask your nurse about our dispensing pharmacy opening in August. We can now provide certain drugs for you to take home, either to inject yourself or to take orally.
Oncology Specialists is proud to have been chosen to design and manage Lutheran General Hospital’s new fellowship program in hematology and oncology. Our first physician-fellow, Dr. Avanti Ragam, began working with our medical staff on July 1. Please welcome her!
To Serve You Better A Newsletter for the Patients of Oncology Specialists, S.C.
Number 3
Summer, 2005
The physicians and staff of Oncology Specialists, S.C. are delighted to welcome two new members to our medical staff.
Dr. Daniel Milton has just completed a fellowship* in Hematology/Oncology at Memorial Sloan-Kettering Cancer Center in New York. Dr. Milton was educated at the University of Notre Dame and Columbia University Medical School. He has a particular interest in lung cancer. Dr. Milton and his wife Molly have two children, and they have just this summer moved to Evanston.
Dr. Sigrun Hallmeyer completed her fellowship* in Hematology/Oncology at the University of Illinois (Chicago) this summer. She is a candidate for a Ph.D. at the Molecular Biology Laboratory, Department of Hematology and Oncology at the University Hospital Charité in Berlin. Dr. Hallmeyer, her husband Mike Milaniak, and her newborn son Johannes live in Chicago.
We are all very pleased to have these new colleagues join us. Not only will they contribute to our ability to serve our patients with the best quality care, but their presence is evidence of the continued growth of our practice and its acceptance by our patients and the physicians who refer them to us.
As you know, after a physician receives his M.D. degree, he undergoes further training as an intern, then a resident, in a hospital setting. A select group of physicians, rather than going directly into full-time clinical practice at this point, undertake further academic work in a clinical setting. These programs, called fellowships, last three years and involve intensive work, usually including research, in a clinical setting under the guidance of academically oriented specialist physicians. As a result, they generally have the highest clinical standards in their chosen field.
All physicians employed by Oncology Specialists are graduates of fellowship programs in Hematology/Oncology.
The Niles office, located in the Oak Mill Center at the corner of Milwaukee and Oakton, has become a busy place since its opening last winter. Drs. Bitran, Galvez, Lestingi, Nabhan, and Richards all have clinics at Niles and our new Prostate Cancer Clinic is held there on Monday afternoons. Patients undergoing chemotherapy treatment at Niles have expressed satisfaction at the ease of parking and the relaxed atmosphere.
Through our arrangement with Oak Mill Imaging, which we participated in establishing, we have been able to offer added convenience for those who require periodic CT scans.
In May, we began a year-long experiment at Niles, providing PET scans to our patients. This service is provided by means of a mobile PET unit that locates immediately outside our clinic each Wednesday morning. If patients and physicians find the service satisfactory, we hope to establish a permanent PET service facility at the Niles location in the future.
The major reconstruction at our Park Ridge location continues this summer. It has proved every bit as challenging as we expected, and we are only grateful for the cooperation of the construction personnel from Power Construction - and the forbearance and good humor of our patients and our staff.
The new parking garage just north of the Cancer Care Center does not seem such a benefit now. But next year, when the construction project is completed, our patients will be able to park there and enter directly into our new clinical facility on the second floor of the Cancer Center (which will be renamed the Cancer Institute).
The construction project still has more than a year to go until it will reach completion. It will go through several more stages, and we will continue to keep you informed of changes as they occur.
In response to an increasing patient load, Susie Sultan has joined our chemotherapy nursing staff, and we have added more physician clinics. We observed the second anniversary of this office in June, and we are delighted at the patient acceptance we have enjoyed at Skokie.
One of our patients received a trip from the Fairy Godmother Foundation to Disney World in Florida.
Next January, Medicare will begin operating its Competitive Acquisition Program (CAP) for the provision of drugs to cancer patients. Under CAP, physicians will be discouraged from purchasing drugs to administer in chemotherapy treatment.
Instead, large pharmaceutical distributors will fill a physician's order for a specific patient and will deliver the drug just for that patient's treatment. The drug supplier will then handle the billing for the pharmaceutical. Delivery of the drug as part of chemotherapy treatment will remain the physician's responsibility.
The CAP program is voluntary and Oncology Specialists will not participate. Here are several concerns we have:
We have always been committed to providing high quality care along with good service to our patients. We seek to control more, not less, of the patient care environment so that we can achieve the standards we believe our patients expect. Turning over control of the drug delivery process for our Medicare patients to a government agency gives up this control, and although it may save us money (and that is uncertain), it will violate our basic principles of good service.
There are some uncertainties about the CAP system that will be introduced, and we will watch carefully how it develops. But for now, we think it is likely to cause more problems than it solves.
To Serve You Better A Newsletter for the Patients of Oncology Specialists, S.C.
Number 2
February/March, 2005
Our very own Dr. Walter Fried has received the American Society of Hematology Exemplary Services Award for his many years of service to the Society in several capacities. We all join in congratulating him.
Change is in the air! The New Year will see significant new developments that will affect Oncology Specialists and all of our patients. Please read this newsletter to avoid surprises.
By mid-January, our practice will open its third clinical facility. The Niles office will be located in the Oak Mill Center at the corner of Milwaukee and Oakton. We will join more than a half-dozen medical practices already in the building, and others will be moving into the mall within the next year.
Our Niles facility, like our offices in Skokie and Park Ridge, will provide all the medical oncology services we offer our patients. Drs. Bitran, Galvez, Lestingi, Nabhan, and Richards will see patients there on regular schedules, and our laboratory, pharmacy, and chemotherapy services will also be available. Also, for the first time, patients of Oncology Specialists will be able to have their CT scans performed at our Oak Mill Imaging Center, immediately adjacent to our Niles office. (See next article)
We believe that our patients will find our new location convenient and the surrounding atmosphere in the Oak Mill mall uniquely pleasant.
Finally, we have taken the opportunity offered by the Oak Mill location to move our billing and accounting departments to Niles. Patient financial counseling remains available at all our locations.
Proper treatment for many of our patients requires periodic CT scans. These scans help our physicians evaluate the efficacy of particular courses of treatment and assess a patient's progress.
Patients and physicians have frequently experienced frustration when CT appointments are hard to schedule, radiology reports are delayed, or films cannot be located. Because this service is so essential to our practice, Oncology Specialists has decided to acquire this service directly in a facility dedicated solely to performing CT scans.
When Oak Mill Imaging opens in January, our patients will be able to have their CT appointments scheduled before they leave the mall. The reports and the scans themselves will be delivered electronically to the desk of our physicians within 24 to 48 hours. And the charge for the scan will be billed by us as part of your normal Oncology Specialists billing.
We expect that the convenient location of Oak Mill Imaging and our direct involvement in its operation will be helpful to both our patients and their doctors.
The construction project that has produced the nearly complete 500-car parking garage immediately north of the Lutheran General Cancer Care Center will enter its second phase in early January. And the new construction will affect everyone who comes to the building.
Any day now, the front entrance of the building on Luther Lane will be closed. The entrance from the parking lot on the south side of the building will become the new main entrance for the next year.
Our lobby and reception areas will be demolished and an entire new front will be added to the building. At the same time, the total redevelopment of the upper floors of the building will begin.
In January, patients will enter the building through the door at the southwest side of the building. Our reception area will be moved to the present Keller Auditorium, next to Apheresis. For now, our chemotherapy, lab, and exam room spaces will remain where they are.
In mid-2006, Oncology Specialists will relocate its first-floor clinical services to the second floor of the newly-renamed Lutheran General Cancer Institute.
In the meantime, this construction will, inevitably, cause inconvenience to patients at the Cancer Center. We will do everything we can to minimize the impact of these changes on our patients.
New Medicare reimbursement policies will be in place on January 1. Patients may see a few changes affecting them directly. But we, and other outpatient oncology services, will be dramatically affected, and this will have an impact on how we deliver chemotherapy services to you. Because of this, we think you should know about the most important changes.
First, the amount Medicare will pay us for the drugs we administer to you will be recalculated. For most drugs, this recalculation will result in a decrease in the amount we will be paid. For some drugs, we will be paid even less than what we buy them for.
Second, the amount Medicare pays for chemotherapy nursing services will be decreased by about 10%.
Changes mandated by Medicare in 2002 have begun to affect our ability to order lab tests. Laboratories such as Quest, our supplier, will no longer perform tests for Medicare patients unless the patient has signed an Advance Beneficiary Notice promising to pay for the test if Medicare disallows reimbursement for it.
We have discussed these matters in separate letters to our Medicare patients during the past several months.
These and other Medicare changes will place a severe strain on practices such as ours. We spend over $20,000 per day to buy drugs that we administer to our patients. We are concerned about our ability to continue to pay for these drugs, and to continue providing the same level of services our patients have come to expect. As the year progresses and we learn more about how cancer care will be affected by these Medicare changes, we will keep you informed.
Welcome: Susan Laurie, Xochitl Chavez, Phillip Gozun, Eva Crown, Susan Kelby, Leslie Murray, Sharon Allen, and Chetna Desai. And thanks to Laura Johnson for her years of dedicated service to our patients.
To Serve You Better A Newsletter for the Patients of Oncology Specialists, S.C.
Number 1
October, 2004
Welcome to the first in what we intend to be a regular series of newsletters aimed at informing you about our practice. We decided to launch this informal publication as a way of helping you understand more about what goes on in this busy place and how we organize the services we deliver to you.
Our office in the Professional Building at Rush North Shore Medical Center celebrated its first anniversary this summer. From the start, we have managed this office as a full-service location with the same equipment, staff capabilities, and physicians as our office in Park Ridge.
Many patients who live in Chicago or close to the Edens Expressway have found Skokie a more convenient location for their physician visits and chemotherapy appointments. Our patients comment on the sense of privacy and personal attention they experience at Rush, and our clinical team there has developed a superb approach to patient support and service.
Both of our offices have fully integrated systems so that patients need call only one phone number to schedule an appointment at either location or to speak to any of our staff. In fact, unless you ask or recognize a voice, you won't know where your call is being received.
In planning our Rush location, we worked closely with the hospital's clinical personnel. This was important so that we would have the highest quality support from the inpatient unit. And the area's first PET/CT unit was installed at Rush as a direct result of our decision to practice there.
The Rush North Shore office was developed to enable us to extend our service capability. Its continued growth has confirmed our decision, and the office remains essential to our plans for the future.
Patients at our Lutheran General facility have grown accustomed this summer to the "e-tablets" they use to record their symptoms when they first arrive for their doctor visit. The tablet computers are part of the AIM Higher program, which we adopted in December 2003 as one of 15 oncology clinics across the country which have been chosen to take part in this initiative to improve the quality of communication between patients and caregivers.
Sponsored by Supportive Oncology Services, AIM Higher has just entered its next phase, the Cancer Support Network (CNS). The CNS is a data repository that will provide patients with expanded information in the form of video presentations and articles that can be printed by the patient while in our clinic. These informative discussions of types of treatment, symptom identification and management, and related topics are designed to give the patient and family an active role in the monitoring and managing disease.
Effective January 1, 2005, the Centers for Medicare and Medicaid Services (CMS) are scheduled to implement a new reimbursement system for drugs paid for by Medicare. According to CMS, the estimated payment for cancer care will be reduced by more than $500 million in 2005, although others estimate this decrease to be close to $1 billion. In total, cancer clinics face a 40-50% decrease in operating reimbursement.
The cancer community is extremely concerned about these scheduled cuts and their impact on Americans' access to quality cancer care.
The new Medicare reimbursement system is a conceptual system that has never been implemented by CMS or any private insurer. Payment for cancer drugs would be based on Average Selling Price (ASP) reported by pharmaceutical manufacturers. Although this sounds reasonable, the ASP system has fundamental flaws. The most important problem is that ASP is not the price we pay to buy drugs. It is a price that is available only to large businesses that purchase the drugs. They resell the drugs to clinics such Oncology Specialists, but, of course, at a markup above ASP.
These and other problems contribute to the fact that many cancer clinics will be paid less than their actual costs, according to CMS preliminary estimates. And these "costs" do not include the cost of maintaining our pharmacy and paying our pharmacists; these extra costs are not reimbursed at all.
Many members of Congress have begun to understand the problems facing cancer care in 2005 and have been working with the cancer community to create solutions. The cancer community has been providing lawmakers and administrators with market data drawn from community cancer clinics (including ours) around the country. Members of Congress have visited cancer clinics to sit in an actual chemotherapy chair and to learn more about the realities and the complexities of treating cancer.
We encourage all our patients to contact their representatives (on the web at http://www.house.gov/writerep/) to support HR 5144, which will slow down the drastic cuts in Medicare reimbursement.
We would appreciate hearing your reaction to this Newsletter. If you would like to comment on any subject, or make a suggestion for future Newsletters, please let us know. Contact our Administrative Director, Mary Beth Mardjetko.
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