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If you thought you could make it through 2012 without learning what the term sequestration means to you and your patients, you had plenty of company.

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"At the beginning of the year, there was confusion and lack of knowledge or just the assumption that this will never happen," said Matt Farber, Director of Provider Economics and Public Policy for the Association of Community Cancer Centers. "But as we are getting closer, people are starting to take note of this and become real concerned."


The concern got numbers attached to it when the Office of Management and Budget issued its report on the effect of sequestration last month.


The 394-page report revealed exactly how the oncology community will fare if the automatic budget cuts go into effect Jan. 1, 2013, as currently planned. "It really is the fact that cancer patients will face a triple threat from sequestration," said Sandra M. Swain, MD, President of the American Society of Clinical Oncology.


Three Major Cuts

In an interview, she noted three big cuts that will come if Congress allows sequestration to proceed:


* $2.5 billion from the National Institutes of Health budget;


* $318 million from the Food & Drug Administration budget; and


* $11 billion in Medicare payments to physicians.



ASCO issued an "action alert" through its ACT Network, encouraging oncologists to call their legislators to ask them to prevent the cuts from taking place.


"We really know it is a challenging [federal budget] environment, but we want to sustain what we have now for cancer treatment and research," she said.


ASCO and ASTRO joined dozens of other medical groups last month in signing a letter asking Congress to avoid sequestration.


Farber said that, because of its session calendar, it is unlikely that Congress will discuss the sequestration threat until December. Even if Congress can agree to eliminate some of the impending cuts at that time, Medicare may not get its attention. That is because sequestration limits Medicare cuts to two percent of its budget, those limits are not in place for many other items. For example, sequestration cuts NIH and FDA budgets by 8.2 percent.


"Given that Medicare is capped at two percent while other sectors of the government are going to be cut more, it might not be at the forefront of what Congress wants to stop," he said.


For oncologists, the Medicare cut will work this way: Physicians submit claims to the Medicare program as usual, and their reimbursement will be reduced by two percent of the total claim. Medicare patients will see no change in their copayment responsibilities.


Farber offers a couple of ideas on how this might play out.


* The current Congress might do nothing, allowing the cuts to go into effect on Jan. 1. The next Congress, which will begin Jan. 3, is likely to have a different political makeup and, thus, might be able to come to agreement about the federal deficit and its sequestration sidekick at that time.


* The current Congress might agree to delay the sequestration cuts for a period of time-say, three months-thereby forcing the new Congress to deal with the issue.



Neither scenario makes the automatic cuts go away easily because the underlying tension over the federal debt and deficit-spending policy will remain.


"For a lot of people who know what the general feeling is in Congress, the issues are coming to a head," Farber said. "They certainly don't want to let these cuts go into place; however, they also don't want to be seen as giving in and allowing the federal debt to increase and doing this deficit spending."


Also among cancer organizations, the American Society of Hematology was one of nearly 3,000 non-defense organizations that sent a letter to Congress in July, asking members to avert sequestration.


'Call-in and Tweet Day'

The Coalition for Health Funding-a nonprofit alliance of many health care organizations, including ASH-has also been active in spreading the word and on September 20 organized a "Call-in and Tweet Day" encouraging people to alert their representatives in Congress to support a balanced approach to deficit reduction that does not include further cuts to "non-defense discretionary" (NDD) programs.


Such programs "represent a relatively small and shrinking share of the federal budget and our overall economy-already reduced to levels not seen since President Eisenhower held office," the Coalition notes.


"They are not the drivers of the debt. In fact, even completely eliminating all NDD programs would still not balance the budget. Yet to date NDD programs have borne the brunt of deficit reduction efforts. If sequestration is allowed to take effect, core services upon which Americans have come to rely will be greatly curtailed or even eliminated."