With an August 31 deadline for comments looming, advocates for radiation oncology in the U.S. are mounting a last-ditch effort to lobby against what they say could be devastating Medicare reimbursement cuts for radiation therapy procedures. Cancer treatment centers are expected to face payment reductions of 20% to 44% if the proposed cuts are enacted.
The U.S. Centers for Medicare and Medicaid Services (CMS) earlier this year proposed to reduce reimbursement for radiation therapy treatments as part of its Medicare Physician Fee Schedule for calendar year 2010. If implemented, the cuts would take effect on January 1.
The American Society for Radiation Oncology (ASTRO), the Community Oncology Alliance (COA), and other professional societies and organizations are lobbying furiously to oppose the CMS proposal. Their primary objective is to differentiate the issue from the Obama administration's healthcare reform initiative and to motivate people to formally comment to CMS by the agency's deadline of August 31.
Devastating impact
The cuts would have devastating effects on radiation therapy providers, opponents believe. Many centers expect to curtail some of the services they provide, while others will be forced to close. Some will not accept Medicare patients for treatment. The impact will be felt by all of the more than 1 million individuals who receive radiation treatment each year for cancer in the U.S., according to ASTRO of Fairfax, VA.
Radiation oncologists throughout the U.S. are alerting patients, local and regional healthcare organizations, radio talk shows, and newspapers, as well as state legislators and congressional delegations. Their message: the cuts would have a catastrophic impact on radiation therapy centers if implemented, with community cancer centers expected to be hit hardest.
ASTRO has met with CMS officials to present data of the cost of operations, to report the results of two surveys about impact on members and utilization, and to differentiate how radiation oncologists use diagnostic imaging modalities from how the imaging is used by the radiology community. One of the society's objections is the proposal's establishment of a 90% utilization factor for radiation therapy equipment, compared with the current rate of 50%.
ASTRO CEO Laura Thevenot sent a letter in July to U.S. Health and Human Services Secretary Kathleen Sebelius and key presidential executive staff pointing out the deleterious effects of the cuts, as well as their inconsistency with President Barack Obama's plan to double cancer research.
Thevenot said that ASTRO's data indicate that the administrative costs of a radiation oncology practice are increasing. "We submitted data showing an 8% average increase in practice expenses, and now CMS wants us to absorb an average 19% decrease," Thevenot said. "We have asked CMS to show us how they made their calculations."
Community Oncology Alliance
Another opponent is the Community Oncology Alliance of Washington, DC, a nonprofit organization promoting community-oriented cancer treatment centers. The organization's executive director, Ted Okon, has rallied COA's members to speak out about the CMS proposal since the proposed reimbursement schedule was published on July 13.
"COA is totally opposed to the CMS proposal, and we are also opposed to any public insurance plan based on Medicare rates," Okon said in a telephone interview with AuntMinnie.com. "The U.S. has the best cancer care delivery system in the world, the majority of which is provided by community cancer clinics."
He believes that the U.S. cancer care system operates "in a crisis mode" because CMS keeps driving down Medicare reimbursement for chemotherapy, radiation therapy treatments, and cancer care services. The ongoing payment reductions could have a long-term impact on the quality of cancer care in the country, he believes.
"Demand for cancer treatment is escalating as the baby boomer population is aging," Okon said. "However, we are starting to lose oncologists relative to demand. Published estimates are that we will have a shortfall of an oncologist for every one in three cancer patients by 2020. We are looking at a catastrophe in the making and the dismantling of the world's best cancer care delivery system."
Okon has been traveling around the country speaking to oncologists, most recently in Illinois, Oklahoma, and South Carolina. COA is encouraging the cancer community of providers, patients, caregivers, and survivors to make their voices heard by sending formal comments to CMS, by writing and telephoning congressional representatives, and by contacting the White House. COA is lobbying members of Congress as well as filing formal comments to CMS.
The view from out West
St. Luke's Mountain States Tumor Institute is a nonprofit hospital-based cancer center in Boise, ID. It serves the entire southern third of Idaho, eastern Oregon, and northern Nevada, a geographic territory that covers hundreds of square miles.
Over the past 26 years, St. Luke's has expanded from a single full-service cancer treatment center, with a trailer park for patients from outlying locales, to a network of five centers stretching from the Oregon border to Twin Falls.
"What we have tried to do over the past three decades is expand our reach so that every center offers all the same treatment services for our predominantly rural residents," radiation oncologist Dr. Ronald Dorn explained. "We are incredibly busy at every one of our offices, with radiation therapy treatment operating at 100% capacity."
Dorn said the facility's Medicare mix represents 60% to 70% of its patients. If the proposed reimbursement cuts are initiated, the center would have to sharply curtail services or potentially close some of its facilities. Patients would need to drive four to six hours each day, because many are ranchers who must return to take care of their animals.
"We don't think that CMS has thought through the full implications of its proposals," Dorn said. "We have made a point of making sure that our entire state legislators and congressional delegates are aware of what will happen. It goes against the entire healthcare initiative being proposed by the White House. It doesn't make sense."
The urban perspective
Dr. Louis Harrison is the medical director of Continuum Cancer Centers and chairman of radiation oncology at Beth Israel Medical Center in New York City. He is also the immediate past chairman of ASTRO and has both a national perspective as well as the experience of heading a major academic cancer treatment center.
"Imagine any enterprise that has to face a 20% to 30% reduction in revenue, and yet is expected to continue business as usual," he told AuntMinnie.com. "How does CMS expect cancer centers to provide the same quality of care to the same number of patients and, at the same time, continue to do research? It is an impossible formula."
Beth Israel Medical Center offers cancer patients nutritional services, counseling in pain management, palliative care, social work services, chaplains, and psychosocial support. These services don't generate revenue and are not reimbursed, Harrison pointed out, but instead are provided from the operational budget and philanthropic donations. He questioned whether Beth Israel would be able to provide the services with a 20% to 30% reduction in revenue.
An untold truth about the U.S. healthcare system, Harrison noted, is that there is not a hospital in the country that could survive without generous philanthropy -- a revenue stream that is drying up with the economy's decline.
"With the proposed CMS revenue reductions, cancer centers are faced with the double whammy of losing a significant amount of reimbursement revenues and not receiving their usual level of philanthropic support," he said.
CMS is requesting comments on its proposed changes through August 31. These can be submitted by writing to CMS if postmarked on August 31, or they can be sent electronically by clicking here.
By Cynthia E. Keen
AuntMinnie.com staff writer
August 27, 2009
Related Reading
Survey: Radiation therapy equipment use far less than 90%, August 17, 2009
Flawed MedPAC survey drives debate on imaging payment cuts, August 11, 2009
ASTRO decries proposed rad therapy cuts, July 30, 2009
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