Laura Thevenot, CEO of the American Society for Radiation Oncology (ASTRO), met with Office of Management and Budget (OMB) officials this week at the White House to again raise concerns about the impact of proposed cuts in the Medicare Physician Fee Schedule. The proposed rule, which includes a 40% reimbursement cut on the delivery of intensity modulated radiation therapy (IMRT), is in final clearance with OMB.
When the final rule comes out, perhaps on November 1, Thevenot hopes the most egregious provisions will be gone, or at least softened. “The chance of them totally reversing everything that it is in the proposed rule is probably not good,” she says. “But I think we made a strong case with Congress.”
Specifically, a bipartisan group of more than 130 members of Congress sided with ASTRO in its effort to protect critical access to radiation oncology services. “Once the final regulation comes out, we’ll be able to figure out whether we have been successful or not,” muses Thevenot. “If we have not been, then we will probably look toward Congress to try to change this legislatively.”
Thevenot concedes that getting favorable legislation attached to a year-ending omnibus bill is a “tough lift,” but she adds, “We have significant Congressional support, and depending on whether the cuts are mitigated, and how much, that would define our legislative strategy moving forward.”
When Medicare announced the proposed cuts on July 6, 2012, ASTRO conducted a survey of its members to
determine possible effects. According to nearly 600 individual survey responses, the proposed cuts could severely impact community-based cancer care nationwide. Respondents indicated that they may limit access to care for Medicare patients, close or consolidate practices, delay or not purchase state-of-the-art equipment, and/or lay-off or reduce staffing—particularly at practices in rural communities.
ASTRO submitted a formal letter to CMS on September 4, 2012 to stress the need for sound data and a rigorous analytical methodology for determining reimbursement rates for physician services. In addition to reducing treatment times for IMRT and stereotactic body radiation therapy (SBRT), the proposed rule presents a number of issues of concern to ASTRO such as the need to:
- properly account for the appropriate number of radiation therapists present during treatment;
- update equipment costs for IMRT treatment;
- close the self-referral loophole for radiation therapy services; and
- identify appropriate interest rates for equipment loans.
Unless the proposed rule is revised or legislation is passed to block the cuts, the cuts will go into effect on January 1.