September 25, 2009 - Cancer physicians and cancer care advocates applauded a bipartisan letter led by Senators Richard Burr (R-NC) and Blanche Lincoln (D-AR) sent to Health and Human Services Secretary Kathleen Sebelius yesterday urging that the Centers for Medicare and Medicaid Services (CMS) spare life-saving radiation oncology services from a major Medicare funding cut proposed for diagnostic imaging services. The 32 Senators signing the letter stated their unanimous concern that these funding cuts could force freestanding and community-based cancer centers to shut down, thereby limiting access to care for seniors - particularly in rural areas.
“As a physician who treats thousands of cancer patients, I am quite shocked by these proposed plans to implement drastic cuts for radiation therapy services,” said Bernard W. Taylor, M.D., a radiation oncologist at Texas Oncology-Longview Cancer Center in Longview, Texas, and Chairman of US Oncology's Reimbursement and Public Policy Committee. "Cuts of this level will most certainly cause many free-standing cancer centers to close, which will lead to longer wait times for patients and less time spent with their doctors. On behalf of the cancer community, we applaud our Senators' bipartisan action in this letter to educate policymakers on the dire impact that this misapplied policy will have on vulnerable cancer patients' access to care."
At issue is a 19 percent funding cut in Medicare reimbursement to the radiation oncology specialty contained within the CY 2010 Physician Fee Schedule Proposed Rule, equating to cuts of up to 44 percent for certain radiation therapy treatments. Of particular concern in the rule is a proposed policy that raises the utilization rate for certain medical equipment from 50 to 90 percent.
This CMS proposed policy appears to have been derived from a recent Medicare Payment Advisory Commission (MedPAC) report. The proposed rule misses a critical distinction made by MedPAC in recent comments and highlighted in the Senators' letter: radiation therapy is therapeutic and should not be included in policy aimed at concerns about volume growth in diagnostic imaging.
The September 23 Senate letter submitted to Secretary Sebelius asked CMS to exempt radiation therapy equipment from the proposed utilization rate assumption increase, stating:
Radiation therapy is not diagnostic imaging. Radiation therapy is only provided to beneficiaries who have already been diagnosed with cancer. Equipment used to both treat cancers and guide the treatment is not diagnostic in nature. Instead, it is used to ensure that the dose of radiation required to kill the tumor is delivered to the tumor and not surrounding healthy tissue. We therefore urge that CMS exempt non-diagnostic imaging equipment from the proposed utilization rate assumption increase.
According to the National Cancer Institute (NCI), radiation therapy has been found to be under-utilized, with a variety of barriers, including travel time to care, cited as standing between patients and treatment. Following a review of relevant literature, the Agency for Health Care Research and Quality (AHRQ) found evidence of disparities in radiation therapy use among older patients; women; and African Americans, with the exception of care provided in the Veterans' Administration system. In another study of more than 11,000 women in Florida who had undergone breast conserving surgery, the odds of receiving post-surgical radiation therapy decreased by 3 percent for every 5-mile increase in the distance to the nearest radiation therapy facility.
"We understand and share policymakers' concerns in the need to make certain that payments for medical procedures are appropriate - but established scientific data should be used as a roadmap for such payment formulas, which certainly does not apply here in the case of cuts to radiation oncology services," said Leonard Kalman, M.D., chairman of US Oncology's Public Policy Steering Committee. "Cutting funding for prescribed radiation, which more than 1 million cancer patients rely upon each year in their personal fight against cancer, is quite unsettling - and on behalf of these vulnerable patients, we must work with policymakers to ensure that this dangerous policy is not enacted."
U.S. Senators who signed the letter to Sec. Sebelius are Sens. Richard Burr (R-NC), Blanche Lincoln (D-AR), Robert Bennett (R-UT), Debbie Stabenow (D-MI), Orrin Hatch (R-UT), Bill Nelson (D-FL), Jim Bunning (R-KY), Carl Levin (D-MI), George Voinovich (R-OH), Tom Udall (D-NM), Mike Crapo (R-ID), Michael Bennet (D-CO), Kay Bailey Hutchison (R-TX), Tim Johnson (D-SD), James Risch (R-ID), Evan Bayh (D-IN), John Cornyn (R-TX), Kay Hagan (D-NC), Tom Coburn (R-OK), Mark Begich (D-AK), Lindsay Graham (R-SC), Barbara Boxer (D-CA), Johnny Isakson (R-GA), Kirsten Gillibrand (D-NY), Saxby Chambliss (R-GA), Daniel Akaka (D-HI), Jack Reed (D-RI), Daniel Inouye (D-HI), Mark Pryor (D-AR), Arlen Specter (D-PA), Sherrod Brown (D-OH) and Sheldon Whitehouse (D-RI).
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