by Daniel E. Smith | Nov 8, 2019 12:00pm
Three
of the scariest words in the English language are “you have cancer.”
It was
not long ago that these three words were a death sentence. But today, many new
treatments are helping cancer patients not only survive but thrive and live
long and healthy lives.
Unfortunately,
the Centers for Medicare and Medicaid Services (CMS) is proposing a new rule
that will make it much harder for cancer patients to receive one of these
amazing life-saving treatments. At risk is a highly precise form of radiation
treatment known as proton therapy.
This
webinar will help providers develop patient-centric strategies to modernize
their patient collection infrastructure and increase financial performance.
Unlike
traditional radiation, proton therapy allows doctors to target the bulk of the
cancer-fighting energy on the cancerous cells while minimizing radiation
exposure to healthy tissue, reducing risks to surrounding vital areas, such as
organs and bones. Recognizing these benefits, top cancer centers around the
country have invested in this cutting-edge technology.
Now,
the government is relying on outdated studies in a proposed rule that will
severely limit access to this life-saving treatment.
In its
proposed rule, CMS not only fails to include the well-established guidelines
from the American Society of Radiation Oncology and the National Comprehensive
Cancer Network, it cites an outdated (2014) report from the Institute for
Clinical and Economic Review and a flawed Medicare Patient Advisory Commission
report, in which authors cited old data and ignored clinical expert opinions.
With
the rulemaking process nearing completion, Congress must step in by calling on
CMS Administrator Seema Verma to remove this innovative treatment from the
proposed Radiation Oncology Alternative Payment Model (RO Model).
If
implemented as written, many cancer institutions would be in the difficult
position of not being able to offer their patients proton therapy because the
reimbursement rate would not adequately cover the costs for delivering this
sophisticated technology. As a result, many proton centers may have to shut
their doors, and new ones won’t open as planned. Access to proton therapy would
decrease for all patients—especially in rural and underserved areas—not just
those covered by Medicare.
It
appears that CMS’ rationale for undercutting physicians’ ability to prescribe
proton therapy is based solely on short-term cost-saving objectives rather than
what is the best treatment option for cancer patients. The proposed rule is
penny-wise and pound-foolish. Rather than saving money, this rule will increase
costs to the Medicare Trust Fund over the long term.
Without
proton therapy as a viable option, more patients receiving traditional
radiation will need treatment for long-term side-effects and secondary cancers
later in life. This rule would deny cancer care that could lessen their
suffering and improve quality of life, all in the name of short-term cost
savings.
We
believe the most prudent option is for CMS to remove proton therapy from the RO
Model. If CMS insists on including proton therapy, the only sensible way
forward is to require taking into account current medical guidelines and
considerations for the resource-intensive nature of the treatment and reimburse
accordingly.
Congress
needs to stand up for cancer patients and make sure that CMS does not implement
the RO Model as written. Cancer patients deserve the right to work directly
with their medical teams to determine the best care plan for them.
Letting
a government agency undercut patients’ and physicians’ options—based on
outdated and flawed information, no less—should not be tolerated.
Daniel
E. Smith is the executive director of the Alliance for Proton Therapy Access.
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