H.R. 4473 The Medicare Patient Access to Cancer Treatment (MPACT) Act Introduced by Congressman Arrington
Today, House Budget Chairman Jodey Arrington (TX-19) introduced H.R.4473 the Medicare Patient Access to Cancer Treatment (MPACT) Act of 2023, alongside Congresswoman Debbie Lesko (AZ-8) and Congressman Michael Burgess, M.D. (TX-26). This bill is designed to realign payment incentives within Medicare to save money for Cancer patients and Taxpayers.
The Problem: When a hospital acquires a community cancer clinic, it often becomes an off-campus hospital outpatient department (HOPD). Due to the way HOPDs are reimbursed, Hospitals are able to charge Medicare a “facility fee” for HOPD services (regardless of whether the HOPD is on or off campus) in addition to the Medicare Physician Fee Schedule (PFS) amount. This can mean that cancer care services are reimbursed at rates 2 - 3x higher than in the physician’s office. For example, under the 2023 Medicare PFS:
- Chemotherapy at a physician’s office costs $129, but Chemotherapy at an HOPD costs $333.
- Aggregate, utilization weighted payment for drug administration services is approximately 164% higher in the HOPD.
- Similarly staggering disparities exist in radiation therapy
Seniors feel these costs adding up because Medicare beneficiaries typically pay 20% of the total cost of a doctor’s visit in coinsurance. They also lose access to local providers, because this policy incentivizes large hospital systems to acquire independent, community cancer clinics, leading over 700 clinics to be acquired by hospitals between 2008 and 2020.
The Solution: Medicare must adopt site-neutral payments to reduce the burden of cost on patients and families of patients receiving lifesaving cancer care. The MPACT Act, introduced by Representatives Jodey Arrington (R-TX), Debbie Lesko (R-AZ), and Michael Burgess, MD (R-TX) will change Medicare payment policy so that seniors are charged the same rate for cancer care regardless of where the care is delivered. Furthermore, by realigning payment for cancer care to service, rather than location, this fiscally responsible legislation will also ensure that American Taxpayers’ money is being spent in a responsible and efficient manner.
The MPACT Act will:
- Level the playing field in Medicare reimbursement for outpatient cancer care.
- Ensure patient access to high-quality, cost-effective care in community cancer clinics.
- Eliminate financial incentives for hospital acquisition of community cancer clinics, which drive up health care costs.
“Unnecessary costs in health care are not only breaking the bank of working families, they are bankrupting our country. We are long overdue for common sense health care reforms like the MPACT Act, which will level the playing field for cancer care facilities, provide better access for cancer patients, and save taxpayers significant costs,” said Rep. Arrington. “Patients, providers, and taxpayers should pay the same amount for the same service, regardless of the setting.”
“Often, health care services for Medicare recipients conducted in hospital outpatient departments, including oncology treatments, are reimbursed at a higher rate than the same services provided in a private practice setting. This unnecessarily drives up spending in our health care system. I am pleased to join Congressman Arrington in introducing this important legislation to help reduce this discrepancy in reimbursements and save money for cancer patients,” said Rep. Lesko.
"The MPACT Act is a critical response to the ongoing issue of uneven reimbursement in cancer care. Its implementation of site-neutral payments ensures that patients are charged equitable rates, regardless of where they receive their care," said Rep. Burgess. "This transformative legislation not only promotes greater accessibility to cost-effective cancer treatments but also addresses the troubling trend of hospital acquisitions of community cancer clinics. By leveling the playing field, the MPACT Act empowers patients and safeguards the integrity of independent clinics, ultimately advancing the goal of providing high-quality care to American Patients."
FIND THE ONE PAGER HERE, CLICK HERE TO SEE THE BILL TEXT.