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Radiation centers face steep payment cuts


Proposed cuts by the Centers for Medicare & Medicaid Services in Medicare payments for radiation oncology services would force an estimated 30% of community-based radiation therapy centers to close their doors, according to a statement sent to CMS by the American Society of Radiation Oncology.

Washington-Proposed cuts by the Centers for Medicare & Medicaid Services (CMS) in Medicare payments for radiation oncology services would force an estimated 30% of community-based radiation therapy centers to close their doors, according to a statement sent to CMS by the American Society of Radiation Oncology (ASTRO).

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In the statement, ASTRO Chief Executive Officer Laura I. Thevenot took issue with proposed payment revisions that would slash radiation oncology payments by 5%-7%, and possibly higher, depending upon the clinic’s patient population. 

Cuts would have ‘detrimental effect’

“The proposed cuts follow on cuts of more than 20% to freestanding centers over the last 6 years,” ASTRO said. “The additional impact of both the equipment utilization rate assumption change and the removal of direct practice expense inputs for image guidance would have a detrimental effect on the ability of many freestanding practices to remain viable. This could limit access to care for cancer patients, particularly in rural and medically underserved areas.”

In addition to those practices that told ASTRO in a survey that they may have to close, 62% said they might have to consolidate practice locations and about 41% were concerned they would have to discontinue accepting Medicare patients.

“The proposed cuts are too deep and too fast for many freestanding oncology centers to absorb,” Thevenot said. “We urge CMS to work with radiation oncology stakeholders to protect access to radiation therapy services by significantly limiting these proposed cuts and reconsidering several proposed policies.”

NEXT: ASTRO took concerns to Congress


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ASTRO took its concerns to Congress, and as a result, more than 200 lawmakers signed letters expressing concerns about the proposed cuts to radiation oncology. The letters were organized by Sens. Richard Burr (R-NC) and Debbie Stabenow (D-MI) and Reps. Devin Nunes (R-CA) and Paul Tonko (D-NY). Their letters were signed by 167 House and 40 Senate members.

Thevenot explained that a significant portion of the cuts were due to changes in how CMS accounts for the costs of the use of linear accelerators and associated imaging equipment, both essential to the delivery of safe and effective radiation therapy.

“By delivering top notch care close to home, community cancer clinics are an essential part of our healthcare system,” Tonko said. “By asking CMS to reevaluate these flawed cuts that could harm patients with a diagnosis of breast or prostate cancer, we can ensure that community cancer clinics will be open for those in need.”

NEXT: Interoperability becoming serious problem


Interoperability becoming serious problem

Meanwhile, in another development involving cancer care, the American Society of Clinical Oncology (ASCO) held a congressional briefing in September on Capitol Hill to inform lawmakers and key staff members about how the lack of interoperability in health information technology (HIT) is becoming a serious problem.

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During the briefing, ASCO outlined steps Congress should take to advance the widespread interoperability of electronic health records (EHR) and prevent “information blocking,” which artificially limits efficient sharing of information between medical practitioners.

ASCO pointed out in a position statement issued during the briefing that the Office of the National Coordinator for Health Information Technology defines an interoperable HIT system as one that “makes the right data available to the right people at the right time across products and organizations in a way that can be meaningfully used by recipients.”

To meet this standard, ASCO said, all HIT initiatives must be able to electronically share clinical information between practitioners.

“The treatment of cancer is complex, often requiring coordination of care and the exchange of detailed clinical information among multiple health care providers using different health information systems,” observed ASCO President Julie M. Vose, MD. “Widespread interoperability for sharing electronic health information is not just a matter of efficiency, but critical for optimal cancer care. It is essential to help patients and physicians navigate the complex continuum from diagnosis through treatment and beyond.”

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ASCO pointed out that EHRs often contain data that cannot easily be shared among physicians or contributed to quality improvements, public health reporting, or analytics. In addition, ASCO said it is observing a growing trend in commercial business practices that are creating barriers to interoperability, including information blocking-the practice of knowingly interfering with the exchange or use of electronic health information.

ASCO said that while some information-blocking results from efforts to protect privacy and security, other more troubling developments are occurring, including:

• per-transaction fees for each import or export of information to a different platform for electronic health information

• refusal to establish connections to permit information exchange with systems developed by competitors

• technological limits to the amount of historical information that can be exported to a recipient on a different company’s EHR platform

• contractual requirements that give an EHR company exclusive license to use a provider’s data.

In July, the House of Representatives passed the 21st Century Cures Act, which contains language addressing interoperability concerns, an action that Dr. Vose said was “significant.”

“We ask that the Senate adopt that language because further delay in this effort will be detrimental to patient care,” she said.



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