Proposed Medicare cuts to radiation therapy are bad medicine

Published by The Hill
Christopher M. Rose, MD
September 3, 2015

Cancer is a cruel disease. It is unpredictable and indiscriminate, and it continues to take nearly 600,000 American lives each year. Yet despite its unforgiving nature, countless patients continue to show resolve in the face of adversity. And with each passing day, more and more of our friends, family, and loved ones win the battle against cancer – something once considered impossible.

Advances in technology and vastly improved treatment methods have allowed us to better identify, target, and treat cancer. Accordingly, survival rates have improved for many types of cancer.

As a practicing radiation oncologist and the chief technology officer of Vantage Oncology, a member of the Radiation Therapy Alliance – a coalition of 296 freestanding cancer care facilities in 35 states caring for more than 100,000 patients annually – I witness daily improvements in care that positively impact patients and their families. And with a continued effort towards innovation, there is truly hope for a better, healthier future where many cancers will be abolished and others managed as a chronic disease, much like heart disease or diabetes.
We’ve truly reached a tipping point in the management of cancer.

For this reason, it is especially alarming that the Centers for Medicare & Medicaid Services (CMS) is threatening the vitality of critical cancer care services in its proposed Physician Fee Schedule (PFS) regulation for 2016. The proposed rule would cut payments to freestanding radiation therapy centers by six percent in 2016. This is on top of cuts to freestanding centers that have totaled almost 20 percent over the last decade.

These proposed changes could have devastating effects on the delivery of cancer care, particularly care provided in freestanding radiation oncology centers nationwide. By cutting payments to cancer care providers, the government is putting at risk an important safety net for millions of Americans in need of radiation therapy – and, in turn, jeopardizing the health and wellbeing of our nation’s most vulnerable patients.

Simply put, the proposed cuts are bad medicine for America’s cancer care providers and their patients. Nearly 65 percent of all cancer patients are treated with radiation therapy during their course of care. And nearly 40 percent of all radiation therapy is currently delivered in a community-based, freestanding setting. As a result of recent cuts in the 2016 PFS proposed rule freestanding centers will now be paid at 80 percent of overall hospital rates. This is indefensible even though the direct costs for the services, the quality of care, and the outcomes of the care are identical. It will be impossible for many freestanding facilities to survive.

Treatment for specific cancers – prostate and breast cancer – would experience the most damaging cuts. If the proposed PFS changes were adopted, the payments for a course of care for prostate and breast cancer will be reduced by 25 percent and 19 percent, respectively. Furthermore, this same care will be reimbursed 36 percent less and 32 percent less, respectively, in the freestanding setting than care delivered in the hospital setting.

This prospect is particularly alarming for minority populations, which experience higher rates of both prostate and breast cancers, according to data from the American Cancer Society. In fact, 37 percent of all new prostate cancer diagnoses in the U.S. are among African American men and 33 percent of all new breast cancer cases are among African American women.

If more radiation therapy centers are forced to close due to Medicare cuts, all cancer patients will suffer, however individuals from minority populations will likely feel an even greater impact. For years, freestanding radiation therapy facilities have played a fundamental role in bolstering access to high quality cancer care among traditionally underserved minority populations and, in turn, elevating health outcomes. Peer reviewed research shows that limited access to radiation oncology in less populated areas is associated with increased rates of prostate cancer mortality. Peer reviewed data also show longer travel times to an oncologist are associated with lower rates of breast conserving therapies. By cutting reimbursement rates to freestanding oncology centers, the government is threatening critical cancer care services.

We can and must do better. We have made important strides in cancer care. There are rational ways to normalize reimbursement across the continuum of care delivery environments. Let’s make sure we protect these vital services in the freestanding setting and protect patient access and choice for those battling cancer.

To that end, I urge Congress to ask their colleagues at CMS to reconsider these potentially devastating cuts to freestanding radiation oncology. Let’s not turn back the clock on cancer care.

Rose, FASTRO, is the chief technology officer of Vantage Oncology, Inc.

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