We are giving our patients information regarding the impact of the cuts to Medicare reimbursements and are asking them to make their voices heard with their legislators if they have concerns about how the reductions are affecting their care.
—Hillary Hahm, MD
With a roster of over 600 members that includes community and institutional oncologists, administrators, registered nurses, and patient navigators, the Georgia Society of Clinical Oncology (GASCO) is one of ASCO’s largest State Affiliates. Founded in 1986, the Atlanta-based Society is active in developing new programs to serve its members and ensure patient accessibility to cancer care throughout the state.
In 2010, with a $10,000 State Affiliate Grant from ASCO, GASCO established a patient navigator society, Cancer Patient Navigators of Georgia, to improve the effectiveness of cancer screenings and patient follow-up services. Two years later, GASCO received another State Affiliate Grant to implement the new survivorship care standards recommended by the American College of Surgeons Commission on Cancer.
The program includes a process to develop and disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing their treatment by 2015. To reach a demographically diverse patient population, GASCO identified three sites in Northwest, West Central, and Southeast Georgia, and is currently testing and evaluating the survivorship care plan template for effectiveness and physician and patient compliance.
The ASCO Post talked with GASCO’s President, Hillary Hahm, MD, about the success of the patient navigator program, the launch of an e-tumor board, and how the sequester budget cuts to Medicare are impacting oncology practices and patient care in Georgia.
Patient Navigator Society
How has the formation of a patient navigator affiliate improved patient care in Georgia?
The fact that there is now a unified patient navigator society in which navigators can be supported by GASCO resources has already resulted in increased navigator availability to provide assistance to patients and their families and has improved care for our patients. Now, navigators from community- or hospital-based settings and from both urban and rural parts of the state can more easily interact with each other and determine which patient navigator programs work best in each environment.
Web-based Tumor Board
What was the impetus for the development of GASCO’s new Web-based oncology tumor board?
We received an ASCO State Affiliate Grant to launch an e-tumor board that is being piloted at a few sites throughout the state. The program is being driven through Georgia Regents University, which is part of the Medical College of Georgia and Georgia Health Sciences University, in Augusta. GASCO purchased Web-based cameras for some test site community practices in Rome and Dublin, Georgia, so oncologists can share radiology images and case discussions of specific tumor types, including colon and pancreatic cancers and glioblastoma, with disease-specific tumor board members at Georgia Regents University.
The ability for community practices to be able to collaborate and network with experts in these cancers is invaluable. Our hope is to eventually have multiple practices across the state linked with the tumor board, but finding funding to expand this project and others is difficult. Our Society is starting a foundation so we can attract funds to support these sorts of important projects. The more we have the ability to communicate across the state, the more we can work together as an association.
Impact of Sequestration
In April, an additional 2% cut to Medicare went into effect as part of the federal budget reduction known as sequestration. How is the reduction in physician reimbursement impacting your members?
It is having a major impact. Even before the sequester took effect, previous reductions in Medicare reimbursement were causing many community practices to send patients being treated in the office to other facilities because they could no longer afford to treat these patients. Fortunately, we are still able to deliver high-quality care in hospital settings, but any disruption in cancer care or change in location can be very difficult for patients.
There is a huge financial stress on oncology practices today, and any reduction in reimbursements has the potential to push more practices either out of business altogether or to join hospital-based systems.
We are giving our patients information regarding the impact of the cuts to Medicare reimbursements and are asking them to make their voices heard with their legislators if they have concerns about how the reductions are affecting
Are you currently sending your patients to other medical facilities for oncology care?
Yes. Patients that I previously treated in my office I’m now sending to a hospital I’m affiliated with. It’s a disruption of our care and it’s very, very difficult for patients, but I can no longer afford to treat all Medicare patients in my office. We can ride this out for a while, but if this is the new normal of how care is going to be delivered, then I think it will adversely affect more and more community practices and more and more patients.
Is GASCO active on a local and national level to advocate for the needs of its members and patients?
We have a wonderful lobbyist who represents our association with our state legislature and representatives, as we try to educate our legislators about the impact of decisions like the reduction to Medicare reimbursements. We are doctors, but we are also small business owners and part of the financial engine of the state, so keeping our practices viable is critical to the state’s economy.
In addition to trying to reinstate Medicare reimbursement levels and add our assistance to what ASCO is doing nationally, we are also active in two other major areas: Georgia has one of the lowest sales taxes on tobacco products in the nation, and we are involved in lobbying for a tobacco sales tax increase. Georgia is also one of the states without an Oral Chemotherapy Parity law, and we are seeing major problems in our community practices as a result. We have effective oral drugs, but because the pharmacy benefit portion of insurance drug plans requires that patients pay a certain percentage of the drug cost, patients are having a hard time affording the copays. In my practice, we employ a full-time person just to coordinate drug assistance programs to help patients with drug copays.
As a Society, we try to be active legislatively and make our voices heard, but when it comes to impacting legislation, sometimes you have to keep sending the same message over a long period of time before you get results. ■
Disclosure: Dr. Hahn reported no potential conflicts of interest.