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Puckrein: Changes to Medicare Part B Pose Risk to Rural Minorities

Living in rural America has many advantages — cleaner air, lower-cost housing, and peace and quiet are just a few of them. But access to health care is not one of the benefits of being on the frontier.

Rural residents are more likely to be uninsured or underinsured, to develop chronic illnesses and to have trouble finding qualified doctors than residents of urban areas.

Minorities in rural areas are at even greater risk. They’re more likely than their white neighbors to be obese and to have diabetes. And they’re more likely to be poor. Roughly three-quarters of our nation’s high-poverty rural counties are home to predominantly racial and ethnic minorities. Specifically, 47 percent of these counties are African-American, 17 percent are Hispanic and 9 percent reflect low-income American Indians.

Several articles have reported that Part B cuts could be part of the fiscal cliff deal once lawmakers figure out what programs to trim. If that passes, rural Americans suffering from serious illnesses such as cancer, multiple sclerosis and rheumatoid arthritis may have to travel further or be unable to get the medical care they need.

At issue is the way that doctors are reimbursed for drugs delivered to patients covered by Medicare Part B. These medications must be administered in doctors’ offices because dispensing them requires a physician’s expertise.

At present, doctors buy the drugs, administer the drugs to patients, and then bill Medicare and other payers. Medicare remits the “average sales price” for the drug plus an additional 6 percent. That extra 6 percent helps to cover the special costs for handling such advanced drugs, such as highly trained staff, shipping fees, secure storage and other overhead expenses.

Some in Congress want to cut the 6 percent add-on, which, in turn, could limit some physicians’ ability to continue to provide these important medications. Proponents claim that such a system will save money by fixing costs and reducing waste.

But there’s not much waste to wrest out of the system. In fact, some drugs already cost physicians more than the current reimbursement rate provides. Slashing Medicare Part B payments could force some doctors — particularly rural ones that may be serving minority families — to take a loss on some of these drugs.

The effect on rural communities could be devastating. Some physicians could be forced to stop offering the drugs to the patients or to close their doors altogether — both of which could mean patients in rural areas might need to travel longer distances or forgo care altogether.

Some doctors are already struggling. A study by the Community Oncology Alliance found that in the past four and a half years, nearly 250 oncology clinics have shut their doors. Another 400 are struggling financially

The problem may be even worse for minority families in rural areas. Rural communities with high proportions of black and Hispanic residents are four times as likely as others to have a shortage of physicians, regardless of community income, according to a 2005 study published in The New England Journal of Medicine.

The consequences of these disparities in access to care are felt across the health care system. According to the South Carolina Rural Health Research Center, rural minorities already experience marked disparities in access to flu shots and colonoscopy and sigmoidoscopy screenings. And rural black women are less likely than the overall population to receive mammograms.

By targeting Medicare Part B for cuts, Congress has trained its eye on a program that delivers critical care in a cost-effective manner. Some physicians are already struggling to keep their doors open, and these cuts could have a serious unintended consequence of further hampering access to care for minority patients.

Reining in health care spending is important. But any proposal that takes doctors away from already underserved minority communities is one we can’t afford.

Congress should be working to improve minority families’ ability to access health care — not to further restrict it.

Gary Puckrein, Ph.D., is president and CEO of the National Minority Quality Forum. He also serves as executive director of the Alliance of Minority Medical Associations, a collaborative effort of the Asian and Pacific Physicians’ Association, the Association of American Indian Physicians and the National Medical Association.

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