Officials at the American Society for Radiation Oncology (ASTRO) hope a 16-page letter to CMS will help reverse a proposed 15% reduction in payment for radiation oncology services. CMS floated the decrease in late July as part of the 2013 Medicare Physician Fee Schedule (MPFS).
With a final rule likely to be released in late October or early November, the stakes are high for both radiation oncology practices and the patients who use these services. “We have been told by a number of companies, particularly small ones in rural areas, that they would simply have to close with these reimbursement numbers,” says Michael L. Steinberg, MD, FASTRO, president of the ASTRO Board of Directors. “As a result, these cuts would have a draconian impact on patient access. Hopefully, saner minds will prevail at CMS.”
CMS is looking to cut $300 million per year from the roughly $1.9 billion allocated for radiation oncology. Steinberg maintains that no other specialty is taking such a hit—a particularly galling development considering that even larger chunks of money are being doled out for less effective treatments. “All of the Medicare money spent on radiation oncology does not amount to what is spent on red cell growth factor,” he muses. “That one drug, that never cured anybody of anything, garners a lot more than all of radiation oncology.”
The most significant portion of the proposed cuts would reduce reimbursement rates 40% for the delivery of intensity modulated radiation therapy (IMRT) and 28% for stereotactic body radiation therapy (SBRT)—mostly due to changes in the assumed treatment times. Treatment duration represents one of many issues outlined in detail in the ASTRO letter. “Much to our astonishment,” laments Steinberg, “CMS went to Web sites and took anecdotal information that specifically did not apply to actual treatment times.”
Cancer patient groups are also expressing concern about the potential impact of the cuts and the reliance on patient education materials as a data source in complex reimbursement decisions. On September 4, the Cancer Leadership Council (CLC) submitted a comment letter recommending that CMS reverse the impending cuts to radiation oncology to ensure that cancer patients will continue to have access to high-quality radiation therapy. Signatories on the CLC letter include the American Cancer Society Cancer Action Network, Susan G. Komen for the Cure Advocacy Alliance, the Lance Armstrong Foundation, and the National Coalition for Cancer Survivorship.
“We think we gave reasonable arguments as to why CMS officials were incorrect,” adds Steinberg. “Some may say this is about money in our pocket, but here at ASTRO our primary goal is to have appropriate access for all patients. We want to be good stewards for the health system and the health care dollar.”