Radiologists have much to dislike in the Centers for Medicare and Medicaid Services (CMS) proposed changes to the 2013 Medicare Physician Fee Schedule (MPFS), and they are not alone. Radiation oncologists would be hit with a 15% reduction in payment for services, says the American Society for Radiation Oncology (ASTRO). Almost half of that cut is due to a change by CMS in the treatment times for IMRT and SBRT procedure codes.
Michael L. Steinberg, MD, FASTRO, president of the ASTRO Board of Directors, called the 7% cut a “concern” and a “surprise,” primarily due to what he viewed as CMS’ faulty reasoning. Instead of researching treatment times, CMS looked at online patient education materials and used the time estimates on these websites to reevaluate IMRT and SBRT reimbursement.
“CMS went outside of the accepted methodology and said that they got information from public sources and Web sites,” says Steinberg. “I went to some of the sites and saw some generic references, for example, to 15 minutes of treatment. Does that mean 15 minutes when the beam is on? None that I looked up had reference specifically to IMRT or SBRT.”
According to Steinberg, there is an accepted methodology to evaluate practice expense, and the two codes—77418 for IMRT and 77373 for SBRT—have gone through that methodology in recent years.
“CMS has gone outside of the methodology to something that is a bit more anecdotal,” contends Steinberg. “If this needs to be looked at yet again, that’s OK with us. But let’s do it through the formal process of the relative value update committee, not the so-called non-vetted public sources.”
A Nevada-based urban radiation oncology practice cited in an ASTRO press release reports, “Every year we do more and more with less. Even a 10% cut would be devastating for our patients, staff and community. We would need to let employees go, which would be devastating for our economy, and our patients would suffer with decreased access to life-saving cancer care.”
Steinberg, who also serves as professor and chairman of Radiation Oncology at the David Geffen School of Medicine, University of California, Los Angeles, agrees that patient access could be jeopardized, and small practices may find it difficult to break even if the cuts are not averted. “I am hopeful this will be changed,” he says. “In the past, I have found CMS reasonable to deal with. I think we have reasonable suggestions to make so that this draconian change can be mitigated.”
Preliminary results from ASTRO’s member survey back up the dire predictions, with early returns indicating that cuts could affect many practices—particularly in rural communities. Survey responses reveal that practices could be forced to close their doors, delay or prevent new equipment purchases, lay-off staff, and limit the acceptance of Medicare patients.