There Is Bipartisan Opposition to CMS Proposed Cuts to Radiation Therapy

Published by Roll Call
Chris Rose
October 8, 2014

For those of us who have never personally been affected by cancer, it can seem a surreal and distant concept; something that happens only to someone else’s family. Until it reaches into your own life, cancer is just a word — though one seemingly laden with emotion. It is a struggle we watch from afar, a battle we don’t quite grasp. As we grow older, we start to understand the disease. As loved ones are diagnosed — young and old and without discrimination — we are forced to learn. Even among fear and sadness, we become deliverers of optimism because it is the only thing we can give to those in need.

For patients, cancer is an omnipresent opponent. The disease is a personal struggle for life. It is a battle we face not only for ourselves, but also for our families and our friends. It is a battle that 41 percent us will face. And it is a battle than can be won, even against great odds.

Treatments such as radiation therapy can help improve those odds. Sixty percent of all cancer patients will receive some form of radiation during their treatment.

Radiation therapy is a trusted and effective treatment method, utilizing some of the most advanced technologies currently available to combat cancer.

Radiation therapists use state-of-the-art, high-energy radiation to shrink tumors and kill cancer cells with exacting precision. In fact, radiation therapy is so effective that following treatments, patients generally suffer minimal side effects. Most importantly, however, this treatment helps thousands of patients win their battle against the disease, as cancer survival rates continue to improve.

However, radiation oncologists and the freestanding facilities where they work are facing public policy obstacles in their pursuit of delivering this care, the end result of which could have potentially devastating consequences for cancer patients across the country.

In the 2015 Physician Fee Schedule Proposed Rule, the Centers for Medicare & Medicaid Services proposed changing the way radiation therapy centers are recognized for the expenses inherent in creation and construction of the vault.

This proposed change, if implemented, would result in a marked decrease in reimbursement such that physicians would not be able to afford to acquire the equipment necessary to deliver precise, effective and safe treatment.

Should the proposed rule be finalized, it would result in a 6 percent cut to radiation therapy centers. This would be on top of a 20 percent cut in pay for freestanding radiation therapy centers that has taken place over the past 10 years. Last year, a leading radiation therapy provider declared bankruptcy as a result of these cuts.

If reductions of this magnitude take effect, they will severely undermine the delivery of cancer care for all Americans, both those who rely on Medicare for their insurance coverage but also younger cancer patients who may lose access to some care if facilities are forced to close.

In addition to risking patient access to care, the CMS’ proposed change is financially imprudent. Medicare pays significantly more to hospitals than freestanding facilities for radiation therapy services and the proposed rule will exacerbate that differential by cutting payments to freestanding facilities while giving a boost to hospital-based doctors. Such a change wouldn’t save the taxpayer money. Instead, it would lead to more Medicare spending as hospitals would begin to treat more patients and freestanding setting would treat fewer.

Fortunately, numerous members from both sides of the aisle have recognized this harmful proposal and expressed concerns directly to CMS Administrator Marilyn Tavenner. Recently, bipartisan letters led by Sens. Debbie Stabenow D-Mich., and Richard Burr, R-N.C. with 34 of their colleagues, along with a House letter led by Reps. Paul Tonko, D-N.Y. and Devin Nunes, R-Calif., and 128 of their colleagues, were sent to Tavenner asking that these proposals be reconsidered.

It is now back in CMS’ court. It has the chance to make this right. Its final decision on the classification of the radiation treatment vault won’t happen until early November. Hopefully, it will consider the facts, reconsider its proposed action and recognize radiation treatment vaults are a direct practice expense.

The right decision by the CMS is the right decision for both patients and taxpayers.

Dr. Chris Rose is chief medical technology officer for Vantage Oncology and a member of the Radiation Therapy Alliance.

See the original article here.