Medicare takes a swing at radiation oncology; ASTRO swings back

September 4, 2009

Freestanding and community-based cancer centers will be leading with their chins if the Centers for Medicare and Medicaid Services revises its reimbursement rules on equipment utilization.

Freestanding and community-based cancer centers will be leading with their chins if the Centers for Medicare and Medicaid Services revises its reimbursement rules on equipment utilization. The proposed rule would increase the utilization rate for radiation therapy equipment to 90% from the current level of 50%. While CMS projects the overall impact of the payment reductions to be 19%, the rates for certain needed cancer services would be reduced by up to 44%, according to the American Society for Radiation Oncology. ASTRO says the change, if it goes through, could cause many of these cancer centers to close, stop accepting Medicare patients, or reduce critical services.

CMS is not singling out radiation oncology. Far from it. The DC bureaucrats want to apply this rule to all owners of medical equipment costing more than $1 million. ASTRO and other groups who depend on such high-tech, big-ticket equipment, including medical imagers, are kicking up a storm about the proposal, labeling it as a roundabout way to reduce expenditures. By increasing the utilization rate, payments for services go way down, adding much needed dollars to a CMS budget that is coming under increasing financial pressure.

Last week ASTRO officially requested that CMS not adopt the proposed change. In its letter to CMS, the society took the opportunity to pick a couple other bones as well, contesting the way CMS calculates practice expenses; citing issues with the proposed changes in malpractice relative value units, as well as its plans to eliminate consultation codes; and calling for significant adjustments to the Physician Practice Information Survey data for radiation oncology. ASTRO gave CMS a detailed analysis showing that data for radiation oncology from the PPIS was improperly weighted and distorted.

"We believe we have identified several areas for CMS to explore as it finalizes the proposed rule for physician services. We hope the agency will consider these recommendations for the sake of the hundreds of thousands of cancer patients we serve each year," said Dr. Patricia Eifel, a radiation oncologist at M.D. Anderson Cancer Center in Houston and chairman of ASTRO.

Helping to convince CMS of the need for such deliberation are Reps. Lois Capps (D-CA), Sue Myrick (R-NC), Mike Rogers (R-MI), and Parker Griffith (D-AK) and 59 other members of the House of Representatives who sent a letter to Health and Human Services Secretary Kathleen Sebelius asking her to reconsider the proposed cuts. A similar letter is circulating in the Senate. Sens. Blanche Lincoln (D-AR) and Richard Burr (R-NC) are among 10 senators already committed to signing the letter.