LUGPA Policy Brief: Medicare Patient Access to Cancer Treatment Act of 2023

Nov. 29, 2023

LUGPA is dedicated to advocating for policies that secure access to quality healthcare, particularly for patients with urological conditions. The Medicare Patient Access to Cancer Treatment Act (MPACT) of 2023 (H.R. 4473) is a pivotal legislative initiative addressing the unique challenges confronting Medicare beneficiaries seeking cancer treatments. This brief offers an overview of the Act's key provisions, emphasizing its significance in enhancing patient outcomes.

Cancer poses a significant public health challenge, especially for the aging Medicare population. MPACT tackles the existing payment disparities between hospitals and independent practices in delivering cancer treatments. LUGPA underscores the importance of equalizing reimbursement to foster fair competition and safeguard the autonomy of community cancer clinics.

Under current Medicare rules, hospitals and physicians operate under distinct and unrelated fee schedules, with hospitals often receiving higher reimbursements for similar services provided by independent providers. This imbalance and the escalating acquisition of physician practices by hospitals have resulted in rising costs for Medicare and private payers.

In 2022, the proportion of physicians in private practice dropped to 46.7 percent, with only 44 percent being self-employed. Notably, according to the American Medical Association, the percentage of self-employed physicians under the age of 45 experienced a 13-point decline from 2012 to 2022, reaching 31.7 percent last year. This shrinking number of independent providers limits patient choice and contributes to increased healthcare expenses.

The reimbursement gap is felt the most strongly in the ambulatory surgical centers owned by many LUGPA members. While these centers offer cost-effective care, they are reimbursed at levels significantly below hospital-based outpatient departments (HOPDs), making it more challenging to provide care. These centers, which also serve patients in areas many hospitals do not cover, often provide more efficient and convenient patient care.

Key Provisions of the MPACT Act (H.R. 4473):

1. Site-Neutral Payment Cuts (2025):
• The legislation proposes payment cuts to services related to cancer diagnosis and treatment at off-campus Hospital Outpatient Departments (HOPDs) starting in 2025, bringing reimbursement closer to the levels received by independent providers.
2. Leveling the Playing Field in Medicare Reimbursement:
• The act aims to ensure fairness in Medicare reimbursement for outpatient cancer care, promoting equal access to high-quality, cost-effective care in community cancer clinics.
3. Patient Access to High-Quality, Cost-Effective Care:
• By eliminating financial incentives for hospital acquisition of community cancer clinics, the bill seeks to guarantee patient access to high-quality, cost-effective care outside traditional hospital settings.
4. Addressing Payment Disparities:
• The legislation specifically targets payment disparities between hospitals and free-standing practices when providing cancer treatments, aligning reimbursement rates with the aim of reducing healthcare costs.
5. Improving Medicare's Solvency:
• H.R. 4473 aims to reduce healthcare costs and enhance Medicare's solvency by equalizing payments for cancer treatment services between independent and hospital-owned practices.
6. Closing the Loophole from the Bipartisan Budget Act of 2015:
• The act addresses a critical loophole in the Bipartisan Budget Act of 2015, which has contributed to payment disparities favoring higher-cost care in hospital-owned off-campus physician practices.
7. Coverage for Cancer Care Planning and Coordination:
• The bill includes provisions for coverage of cancer care planning and coordination under the Medicare program.

The Medicare Patient Access to Cancer Treatment Act of 2023 aligns with LUGPA's commitment to promoting fair competition, preserving community cancer clinics, and ensuring equitable access to high-quality cancer care. LUGPA urges policymakers to recognize the positive impact of this legislation on healthcare costs, Medicare solvency, and the overall well-being of patients receiving cancer treatments.