Medicare cuts a step back in the fight against cancer.

Byline: GUEST VIEWPOINT By David Fryefield The Register-Guard

On Jan. 1 - roughly 90 days from now - Medicare will start slashing payments for many medical imaging services that Medicare patients count on. The cuts will target such services as ultrasound tests, PET scans and CT scans that seniors receive in their doctor's office or in independent imaging centers. These locations are often the most convenient because they are usually close to where seniors live.

As a cancer care physician, I find these cuts troubling. Imaging is a fundamental tool in treating cancer. By making cancer harder to discover, we make cancer harder to stop. And with $8 billion in payment reductions over 10 years, these cuts are sure to undermine many imaging services that are critical in cancer diagnosis and treatment.

I am also troubled as an Oregonian. A study from the Oregon State Cancer Registry in August found that "access to medical care for appropriate screening, as well as treatment, is imperative to reduce the toll of cancer among Oregonians." The report also points out that access to needed care is heavily influenced by the distance that patients have to travel to reach physicians. And a lot of older Oregonians live in rural areas.

With this in mind, consider the massive cuts that Medicare is about to make in imaging services that Medicare patients receive in facilities that are closest to where they live. The cuts are so deep that many physicians who practice in these locations say they will be forced to cut back on imaging services or to stop offering them entirely. One survey by the American College of Cardiology found that 40 percent of physicians said that they would be forced to stop providing imaging to Medicare beneficiaries.

What will happen when seniors face significant access problems and delays in attempting to get the imaging they need? I fear that many will simply forgo the tests or procedures that are critical in managing their cancer.

These cuts will be particularly harmful to cancer patients who would benefit from PET and PET-CT scans to better diagnose their tumors, monitor their response to treatment and more accurately plan future treatments.

This new technology is one of the most cost-effective in medicine, because its accuracy allows physicians to obviate the need for more expensive invasive procedures and helps patients avoid unnecessary chemotherapy and radiation treatments. This saves Medicare and seniors significant amounts of money and, more importantly, gets patients to the right treatments earlier. In recognition of the economic and medical benefits of PET and PET-CT scans, Medicare recently expanded the indications for which it will pay for these scans.

For all of these reasons, we made plans to bring PET-CT technology to the Willamette Valley Cancer Center next year. Yet reimbursement for PET and PET-CT scans will be cut by more than 50 percent on Jan. 1, forcing us to carefully reassess the wisdom of this expensive purchase.

America has finally started turning the corner in the war on cancer, with more Americans than ever before leading healthy lives after beating their cancers. This progress is thanks in large part to innovations in health care developed over the last decade, including new imaging techniques such as PET and PET-CT. Reducing access to the very innovations that are driving these success stories will only turn back the clock for millions of Americans with cancer.

The good news is that Sen. Gordon Smith of Oregon has stepped in. He and Sen. Jay Rockefeller of West Virginia have introduced a bill that would impose a two-year delay on these imaging payment reductions. During that time, the bill would direct the Government Accountability Office to assess how these cuts in imaging payment would affect Medicare patients, especially those who live in rural areas.

This is a reasonable solution, and it is imperative that the bill be approved soon. Congress must understand more fully just how these payment cuts will work their way through the health delivery system. Setting off a chain reaction that ultimately leads to less access for Medicare beneficiaries is hardly what you would call smart health policy.

The Smith bill makes sense. It deserves the support of Oregon's entire congressional delegation.

David Fryefield, M.D., of Eugene is a radiation oncologist and medical director of the Willamette Valley Cancer Center.