Oncology centers say CMS payment model would discourage the use of new technologies

Oncology centers say that a Trump administration proposal to bundle Medicare payments for radiation therapy will discourage providers from using new technologies.

Comments on the five-year model proposed by the Centers for Medicare and Medicaid services came to an end on Monday. Several organizations said the proposed model would significantly reduce payments for a new type of radiation therapy.

The proposed payment model would pay a physician or a radiotherapy center for a selection of services over a 90-day period. The payment would not cover the total cost of all care provided to the recipient, but would only cover certain services such as dose planning, computed tomography simulations and treatment aids.

The purpose of the mandatory model is to address perverse incentives for providers to choose a treatment plan for a patient with a large number of services, even if they are not medically necessary, according to the proposed rule published in July. .

"This structure can encourage suppliers and suppliers to offer longer training courses. [radiation therapy] because they're paid more to provide more services, "said the rule. "It is important to note, however, that the latest clinical evidence suggests that shorter treatment cycles [radiation therapy] for certain types of cancer would be just as effective and could improve the patient experience, potentially reduce the costs of the Medicare program and lead to a reduction in the participation of beneficiaries in their costs. "

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The new model would come into effect on January 1, 2020, but CMS plans to postpone implementation until April to give businesses more time. The model would also apply a "site neutral" test to payments to ensure that the reimbursement is the same regardless of where care is provided.

But oncologists, autonomous oncology centers and other providers said the model would reimburse proton beam therapy at the same rate as other types of radiation therapy, even if proton therapy costs more.

Proton therapy treats cancer using protons rather than X-rays used in traditional radiotherapy. But proton therapy is relatively new and expensive to administer for providers. According to the proposed model, oncologists would be reimbursed less for the use of therapy.

"By setting payment rates that reimburse all terms in the same way, CMS, by its own logic, provides financial incentives to suppliers to use the cheapest modalities, which also tend to be the ones that deposit the largest amount of radiation. in healthy tissue, "said the non-profit provision. CARES Proton Therapy Centers located in Knoxville and Orlando. "This totally ignores the side effects and potential profiles of secondary cancer, which goes against the desire to improve the quality and care of patients."

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The New York Proton Center added in its comments that proton therapy can reduce costly complications in the long run. However, the payment model discourages the use of new technology, the center added.

Several oncology centers also complained that the five-year model would be mandatory.

"Requiring at least 40% of radiation-oncology practices to participate is unprecedented," the Las Vegas Prostate Cancer Center said in comments. The center wanted CMS to make the model voluntary for four years, then install a "limited mandatory model, which would include exemptions for difficult situations and low volume practices".