ASTRO: Proposed 2016 Medicare Cuts Threaten Access to Community-based Radiation Therapy

August 4, 2015 — The American Society of Radiation Oncology (ASTRO) has raised concerns about proposed additional payment cuts to radiation therapy in the proposed Medicare Physician Fee Schedule (MPFS) for 2016, released July 8, 2015. All changes would take effect on Jan. 1, 2016.

Freestanding centers estimate that the combined impact of the Medicare proposals would result in a 5-7 percent reduction in payment for radiation oncology services at community-based centers, although the cuts will vary and could be more than 10 percent for some centers depending upon their patient population.

The proposed CY 2016 MPFS includes several significant adjustments for radiation oncology care. The proposed changes include:

Setting reimbursement values for newly created treatment codes for conventional radiation therapy techniques and intensity modulated radiation therapy;
Increasing the assumed equipment utilization rates for radiation treatment delivery, which has the effect of reducing reimbursement for cancer treatment; and
Removing from the direct practice expense formula the costs associated with important equipment, most notably on-board imaging, which is critical to ensuring safe and accurate radiation treatments.

ASTRO represents radiation oncology physicians practicing in hospitals and community-based clinics and will submit comments and recommendations in a letter to CMS by Sept. 8, 2015.

“The implementation of these three dramatic policy changes at once represents too much, too fast for community-based clinics to absorb and could have devastating effects, particularly for those centers in rural and underserved areas. ASTRO and its members are very concerned that the cumulative impact of recent significant cuts, totaling about 25 percent during the past six years, plus these new reductions could seriously threaten access to care for many cancer patients by potentially forcing clinics to close or limit their services,” said ASTRO Chair Bruce G. Haffty, M.D., FASTRO.

Preliminary data from ASTRO’s approximately two-week survey of the almost 1,400 community-based radiation therapy centers in the United States indicates that with reimbursement cuts of five to 10 percent, nearly 30 percent of the practices may have to close their doors; approximately 62 percent may have to consolidate practice locations; and an estimated 41 percent may be forced to discontinue accepting patients covered by Medicare.

For more information: www.astro.org