Community-Based Radiation Treatment for Seniors with Cancer Threatened by Medicare Proposal

– Millions of Medicare beneficiaries with breast and lung cancer disproportionately affected by Proposed 2014 Physician Fee Schedule Rule ––

WASHINGTON, Oct. 2, 2013 /PRNewswire-USNewswire/ -- New payment proposals from the Centers for Medicare & Medicaid Services (CMS) would continue a decade-long trend of payment reductions for community-based radiation cancer therapies. These reductions undermine providers' ability to care for a growing number of Medicare beneficiaries with cancer.

According to the Radiation Therapy Alliance (RTA), a nonprofit organization representing community-based radiation therapy centers, the proposed CY 2014 Physician Fee Schedule (PFS) would cut payments for radiation therapy by 7.7 percent overall, including cuts of more than 25 percent for certain commonly billed services. Providers fear that the proposed cuts would severely undermine the delivery of radiation therapy to Americans who depend on Medicare—a consequence made all the more dire by the fact that more than half of all newly diagnosed cancer patients are 65 or older.

"We've made tremendous progress in treating certain types of cancer using radiation therapy," said Dr. Connie Mantz, Chief Medical Officer with 21st Century Oncology and a member of the Radiation Therapy Alliance. "Unfortunately, funding cuts like the ones proposed by CMS create instability and could undermine our ability to continue treating patients in safe, comfortable settings close to their homes, with therapies that have been proven effective."

Radiation therapy in community settings has been particularly important for Americans with breast and lung cancers—two leading types of malignancies among the Medicare population. Medicare reimbursement per lung cancer episode treated with 3D-CRT (conventional radiation therapy) has declined steadily, from an average of $14,616 in 2011 to a proposed average reimbursement rate of $11,782 in 2014—a payment drop of nearly 18 percent. Similarly, if the Proposed 2014 PFS Rule is finalized, Medicare payments for breast cancer will be cut almost 19 percent over two years.

"Community based treatments are important to patients, an essential part of the nation's cancer care delivery system, and a good value for Medicare," said Dr. Mantz. "Rather than continued cuts, we need reforms that promote quality care and benefit our patients."

The RTA is urging Congress to establish an episode-based bundled payment for freestanding radiation oncology to align incentives for high quality, efficient care. Such a reform would generate savings for taxpayers, predictability for providers, and, over time, better outcomes for patients.

SOURCE Radiation Therapy Alliance