ASTRO Survey Reveals Potential Impact of Proposed MPFS Cuts for Radiation Oncology

When the Centers for Medicare and Medicaid Services (CMS) released its proposed 2013 Medicare Physician Fee Schedule (MPFS), members of the radiation oncology community discovered that they would face for cuts representing a 15 percent reduction in overall payment. According to the American Society for Radiation Oncology (ASTRO), this would represent a nearly $300 million loss for cancer care services. To give CMS and legislators a better idea of the impact of these cuts, ASTRO opened up a five-day members survey on July 7, the day after the proposed 2013 MPFS was published in the Federal Register. The survey results are now in and they reveal bad news for cancer patients, their care providers and the manufacturers of equipment used in radiation oncology services. Among the 599 ASTRO members who responded to the survey, 93 percent could delay or cancel purchasing new technology. Doctors and other members of the care team might lose their jobs, especially in community-based radiation therapy clinics, which would face a 19 percent reduction in reimbursement, according to ASTRO. Its survey indicated that 53% of community-based practices may lay-off physicians, and 81% of community-based practices may lay-off professional staff. For patients, the cuts would limit access to new technology due to the chilling effect the cuts would have on equipment orders. In addition, patients might be required to travel further for daily treatment and could face access issues. Among the survey respondents:

• 70% reported they might have to limit Medicare patients
• 49% said they may be forced to no longer accept Medicare patients
• 35% percent of respondents in free-standing centers said they may close their practice
• 64 percent of respondents in free-standing centers could have to consolidate practice locations

Putting numbers behind ASTRO’s warnings about the potentially dire effects of the proposed MPFS cuts could help radiation oncology providers gather support among legislators of both parties for forcing CMS to reconsider the cuts. In particular ASTRO wants CMS to hold off on the most significant portion of the cuts, 7% overall, that is due to a change in the treatment times for calculating the RVU for IMRT (intensity modulated radiation therapy) and SBRT (stereotactic body radiation therapy). CMS looked up online patient education materials and lowered its treatment time estimate for IMRT and SBRT after reading the treatment times quoted to patients. ASTRO points out that the treatment times given to patients was never meant to cover all the work that goes into an IMRT or SBRT treatment both before and after the procedure. These times were only meant to cover what a patient would be directly concerned with. “ASTRO welcomes a comprehensive review of these procedure codes and supports the necessary sophistication of a process, such as provided by the AMA Relative Value Update Committee (RUC), to value complex medical procedures including IMRT and SBRT,” said Michael Steinberg, MD, president of ASTRO’s Board of Directors in a written statement. “These processes are in place to ensure that such important policy decisions are made fairly, with relevant professional input.” Legislators on ASTRO’s side so far include Representatives Joe Pitts (R-Penn.) and Frank Pallone (D-N.J.), the respective chair and ranking member of the House Energy and Commerce Committee health subcommittee. With support from Rep. Mike Rogers (R-Mich.), they are circulating a letter among their House colleagues that ultimately will be sent to the Administration. ASTRO says a similar bipartisan letter is being drafted in the Senate.