by Robert King | Sep 16, 2019 3:49pm
Oncology
centers say a Trump administration proposal to bundle Medicare payments for
radiation therapy will discourage providers from using new technology.
Comments
on the proposed five-year model from the Centers for Medicare & Medicaid
Services (CMS) ended Monday. Several organizations said the proposed model
would severely cut payments for a new type of radiation treatment.
The
proposed payment model would pay a physician or radiation therapy center for
select services over a 90-day period. The payment wouldn’t cover the total cost
of all care provided to the beneficiary, but rather cover only select services
such as dose planning, CT simulations and treatment aids.
The
goal of the mandatory model is to address perverse incentives for providers to
select a treatment plan for a patient that includes a high volume of services,
even if they are not medically necessary, according to the proposed rule
released in July.
“This
structure may incentivize providers and suppliers to furnish longer courses of
(radiation therapy) because they are paid more for furnishing more services,”
the rule said. “Importantly, however, the latest clinical evidence suggests
that shorter courses of (radiation therapy) for certain types of cancer would
be equally effective and could improve the patient experience, potentially
reduce costs for the Medicare program and lead to reductions in
beneficiary cost-sharing.”
The new
model would go into effect Jan. 1, 2020, but CMS is considering delaying
implementation until April to give companies more time. The model would also
apply a “site-neutral” test to the payments to ensure the reimbursement is the
same no matter where the care is delivered.
But
oncologists, free-standing oncology centers and other providers were livid that
the model would reimburse proton beam therapy at the same rate as other
types of radiation treatment, even though proton therapy costs more.
Proton
therapy treats cancer using protons instead of X-rays employed by traditional
radiation therapy. But proton therapy is relatively new and costly for
providers to administer. Under the proposed model, oncologists would get
reimbursed less for turning to the therapy.
“By
establishing payment rates that reimburse all modalities the same, CMS, by its
own logic, is financially incentivizing providers to use the cheapest
modalities which also tend to be those that deposit the greatest amount of
radiation in healthy tissue,” said the nonprofit Provision CARES Proton Therapy
centers located in Knoxville and Orlando. “This entirely ignores side effects
and potential secondary cancer profiles, running afoul of the desire to improve
quality and patient care.”
The New
York Proton Center added in comments that proton therapy can reduce costly
long-term complications. However, the payment model discourages the use of the
new technology, the center added.
Several
oncology centers also complained that the five-year model will be mandatory.
“Requiring
a random 40% of radiation oncology practices to participate is unprecedented,”
said the Las Vegas Prostate Cancer Center in comments. The center wanted CMS to
make four years of the model voluntary and then install a “limited mandatory
model which would include exemptions for hardships and low volume practices.”
https://www.fiercehealthcare.com/payer/oncology-centers-say-cms-payment-model-would-discourage-use-new-technology
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