Concern for patients, for profit

WASHINGTON - When Anita De Palma came here from Clearwater recently to lobby against a proposed cut in Medicare funding for cancer treatment, her goal was to help cancer patients.

De Palma knew that her travel expenses were being paid by an organization called US Oncology. But she says she had no idea that it is a for-profit company that stands to lose millions in revenues if the legislation is adopted.

"I didn't even know US Oncology was a company," said De Palma, Florida director of the League of United Latin American Citizens, LULAC, a Hispanic activist group. "I thought it was a grass roots, patient advocacy group."

De Palma made an understandable mistake. The news conference where she spoke was orchestrated to emphasize concern for patients.

None of the press releases distributed there carried the name of the Texas-based US Oncology, the nation's largest chain of outpatient cancer clinics and the sponsor of the news conference.

Joe Bailes, executive vice president of US Oncology who spoke at the news conference, identified himself instead as former president of a professional group, the American Society of Clinical Oncologists, ASCO, which helped to arrange the news conference.

Such tactics are commonplace among the many national organizations that advocate more funding for cancer research and treatment. While most of these groups claim to focus on the welfare of cancer patients, virtually all of them receive generous funding from the pharmaceutical industry and other business interests related to cancer treatment.

None of these groups are required by law to disclose the sources of their income or the amounts they receive from each source. Frequent contributors to the cancer patient groups include Bristol-Myers Squibb, Novartis, Merck, Pfizer, Astra Zeneca and Eli Lilly.

Ellen Stovall, executive director of the highly respected National Coalition for Cancer Survivorship and one of the speakers at US Oncology's news conference, acknowledges that her organization is funded, in part, by oncologists and pharmaceutical companies. Her group does not publicly report how much money comes from these sources.

"I honestly do not know of one cancer group that doesn't take (corporate money)," she said.

She also says business contributors sometimes pressure patient-centered cancer groups to support legislation that would help the pharmaceutical industry, whether or not it would be good for patients.

Stovall says her group never advocates anything that would help drug manufacturers at the expense of patients. But her role in the current lobbying campaign against a cut in Medicare reimbursements for cancer treatment shows how difficult it is to make such a distinction.

While the proposed $16-million cut in Medicare reimbursements would drastically reduce the profits of most cancer clinics and create an uncertain future for companies such as US Oncology, some experts doubt it would undermine patient care nearly as much as the oncologists contend.

"We have no data on exactly what impact this will have on patients," says Fran Visco, president of the National Breast Cancer Coalition, NBCC, another grass roots patient group. ". . . Oncologists should be the ones to argue for a new payment formulas and not expect patients to make the argument for them."

For years, Medicare has grossly overpaid oncologists, by their own admission, for the drugs they use to treat cancer patients in non-hospital settings such as doctors' offices and clinics. That is because the reimbursement formula calls for Medicare to pay oncologists 95 percent of the average wholesale price of the drugs used in treatment, often a figure many times the actual cost.

According to Rep. Nancy Johnson, R-Conn., oncologists pay only about $5 for Vancomycin, an injectable drug, even though the average wholesale price is listed at $382. Meanwhile, Medicare patients are responsible for a co-pay of $73.

In fact, many drug manufacturers are known to set the average wholesale price artificially high to create a financial incentive for oncologists to use their products.

"This is a longstanding problem," says Thomas A. Scully, head of the agency that oversees Medicare. "We pay about $5-billion a year for about 450 outpatient drugs. We pay far more than any other purchaser of these drugs and we've been determined for many years at the agency to try to find a way to fix it."

Currently, the House-Senate conference committee drafting the final version of a new Medicare bill is considering a variety of ways to save the taxpayers millions of dollars by cutting reimbursements for outpatient oncology drugs. Oncologists say the proposed cuts could put many outpatient cancer clinics out of business, forcing patients to travel long distances to receive care in hospitals.

ASCO, the trade association representing oncologists, estimates the changes under consideration on Capitol Hill would cause half of all cancer physicians to limit their treatment of Medicare patients. The group says nearly one in five of them may have to discontinue caring for seniors with cancer.

The group says oncologists have been using the excess to cover the overhead costs related to treating cancer patients, such as the salaries of nurses. If Congress cuts the reimbursement for oncology drugs, ASCO argues, it also must substantially raise the reimbursement for related expenses.

To discourage Congress from implementing the cuts, oncologists have undertaken an aggressive, well-financed lobbying campaign using the slogan "Save Cancer Care."

Serving as the financial engine of the campaign are three groups representing oncologists and clinics: ASCO, which represents about 19,000 physicians; the Community Oncology Alliance, a network of cancer clinics organized by West Clinic in Memphis, Tenn.; and US Oncology, which bills itself as "America's premier cancer-services company" with more than 70 clinics across the country.

Between them, these three groups have hired the services of some high-powered professional lobbyists, including former Reps. Bob Livingston, R-La., and Harold Ford, D-Tenn., as well as two premier public relations firms: Edelman Worldwide and Bonner & Associates.

Instead of speaking on their own behalf, these professional groups get community activists such as De Palma and grass roots cancer patient advocacy organizations such as the National Coalition for Cancer Survivorship to argue their case in public.

At the Oct. 23 news conference, where De Palma sobbed as she talked about her father's cancer death, the speakers who expressed opposition to cuts in reimbursement for cancer care included Sens. Bill Nelson, D-Fla., Stovall, and Bailes. Other groups represented at the event included the Older Iowans Legislature, the Tennessee Baptist Association and the Orthodox Rabbinical Council of Greater Phoenix.

US Oncology's spokesman, Steve Sievert, says his company is not trying to fool the public with this approach. He said the company has emphasized the potential setback for patient access to care to counteract "a continual emphasis" in Congress on the big role that Medicare reimbursements played in boosting the profits of cancer treatment centers.

He said Bailes did not identify himself at the news conference as a US Oncology employee because he was acting in his role as a former officer of ASCO.

Sen. Nelson was unaware that US Oncology arranged the event. Dan McLaughlin, Nelson's press secretary, said the senator was happy to speak out on behalf of cancer patients, no matter who sponsored the event. He said Nelson understands the oncologists have been overpaid for drugs in the past and he has been advocating an equitable solution that would cut drug reimbursements and increase compensation for the oncologists' other practice expenses.

In a memo to NBCC's members she explained that the outpatient oncology reimbursement scheme "has caused some patients to have to pay inflated co-pays," and she questions whether a change in the system would have an adverse impact on patient care.

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