Donna Key, right, explains the circumstances of her neighbor and friend Betty McBee, left, after McBee was dropped by her insurance company after being diagnosed with cancer.

Federal Medicare cutbacks have put some cancer patients in a tough spot, said the chief executive officer at Oklahoma Oncology.

Ken Butcher said Medicare-only patients seeking treatment at Muskogee Regional Cancer Center may have problems if they need chemotherapy.

“The whole problem has been created by the reimbursement policy of the Medicare system,” he said. “The physician reimbursement from Medicare is so close to our cost that physicians have very little room to work with patients who don’t have the means to pay their portion.”

One of those patients is 78-year-old Betty McBee, who said she is now in hospice care because she can’t afford treatment. She also has problems with her former insurance company.

“I went to M.D. Anderson (Cancer Center in Texas) in January, and when I came back, I had received a letter that my secondary insurance had canceled me,” she said. “They said my cancer was a previous condition because in 2005 doctors took out part of my colon.”

That left McBee with only Medicare to pay for health care.

“My doctor here gave me a doctor who comes down here once a week from Tulsa, but he never did get a hold of me,” she said. “Then I heard they wouldn’t take me on account of just having Medicare.”

McBee said her condition has become very serious. She does not have nearby family. She is battling health problems and the insurance company that took her money for several months and then cut her off.

“I’ve got cancer in my head, liver, near my left rib, and several other places,” she said.

Butcher said Oklahoma Oncology had a special arrangement to make chemotherapy available locally.

“If a (MRCC) patient had Medicare only, we sat down with them, looked at the doctor’s order, looked at our cost and what Medicare was going to reimburse for it,” he said. “We would say, ‘What we would like to do is have your infusion in the hospital.’ And the hospital would accommodate that infusion and work with the patient on their co-pay if the patient couldn’t pay all at once. But the hospital (MRMC) shut down their outpatient infusion center this fall.”

Butcher said he understands the situation faced by MRMC administrators and said they “don’t have much wiggle room.”

MRMC CEO Steve Mahan said the infusion center was losing more than $1 million per year treating Medicare-only patients referred by MRCC.

“We approached Oklahoma Oncology and tried to work out a deal where we could take the hit together, but even that would have been an ethical issue,” he said. “If you set the limit at a half-million dollars, what are you going to say to the next patient who comes in? It was one of those hard decisions; we eventually decided it was better not to keep it open.”

Mahan agreed with Butcher that the basis of the entire problem is that Medicare does not reimburse health care providers for their actual cost.

Butcher said his facility continues to provide chemotherapy to people like McBee, but the patient and their loved ones have to travel outside Muskogee.

“Our policy is that we do see (MRCC) patients with Medicare only, but they have to arrange for transportation to one of the hospitals in Tulsa that we have an association with,” Butcher said. “Of course, that means they are depending on a friend or family member for that trip to Tulsa, it creates an additional hardship on the patient.”

Butcher said Oklahoma Oncology and other health care groups have explained their predicament to Sen. Tom Coburn and James Inhofe, both R-Oklahoma, both of whom have been sympathetic. But, Congress has not made a change.

“The Medicare Modernization Act caused an upheaval in reimbursement for medical oncology,” he said. “If you have a patient who is Medicare only, they have personal responsibility for 20 percent of the cost (set by the government). For any given treatment you could be out of pocket $250 to $300. And this isn’t going to happen just once; many of these treatments are monthly.”

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