Policymakers need to be educated on the radical difference between radiation therapy and diagnostic testing

Sep 2 2009

Clinicians and Patient Advocates Applaud Bipartisan Congressional Letter Led by U.S. Reps. Griffith, Myrick, Capps and Rogers Encouraging Federal Policymakers to Spare Radiation Therapy from Drastic Cuts

The following is being released by US Oncology:

Concerned members of the cancer community, including physicians, patient organizations and other care advocates, spoke out today in opposition to a proposed federal policy under consideration by the Centers for Medicare and Medicaid Services (CMS) that would lump life-saving radiation therapy in with diagnostic testing services in receiving major Medicare funding cuts. In support of their cause, a bipartisan letter led by Reps. Parker Griffith (D-AL), Sue Myrick (R-NC), Lois Capps (D-CA) and Mike Rogers (R-MI), was sent to Health and Human Services Secretary Kathleen Sebelius urging a reversal of this proposal.

"I am very alarmed at the prospect of these dangerous funding cuts being made to radiation therapy, which is a safe and effective treatment proven as a trusted tool in the fight against cancer," said Bernard W. Taylor, M.D., a radiation oncologist at Texas Oncology-Longview Cancer Center in Longview, Texas. "For vulnerable cancer patients like mine, this proposed policy would limit their access to vital radiation treatment through longer wait times and less time spent with their doctors. We must educate policymakers on the radical difference between life-saving, therapeutic radiation therapy and diagnostic testing, and the critical need to spare radiation therapy from these cuts."

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 codes critical to the provision of radiation therapy treatments. Of particular concern in the rule is a proposed policy that raises the utilization rate for medical equipment costing over one million dollars from 50 to 90 percent. The lawmakers and other experts in the industry warn that cuts of this size will result in the closing of many freestanding and community-based cancer centers, particularly in rural areas, harming patient access to care.

"As a radiation oncologist who practiced in the community setting, I am aware of how these severe cuts would limit access to life-saving radiation therapy for cancer patients," said Rep. Griffith. "I am proud to be working on healthcare reform to expand access to high quality, effective care for cancer patients and all Americans, and I look forward to working with both parties as well as the administration to find a solution that averts these cuts and protects patient access to care."

The Congressional letter submitted to Secretary Sebelius, signed by more than 60 Members of Congress, asked CMS to refrain from finalizing the proposed reductions in Medicare payment for radiation oncology services, and to refrain from applying a higher assumed equipment utilization rate to radiation oncology equipment. The letter states:

"We are writing you today to emphasize a clear distinction: Radiation therapy is not diagnostic imaging. . . The therapeutic use of radiation to treat cancer should not be the target of those concerned with volume growth in the area of diagnostic imaging."

The proposal to reduce rates for diagnostic imaging was made by the Medicare Payment Advisory Commission (MedPAC) in their March 2009 report. MedPAC has subsequently stated that it never intended to include radiation therapy in any Medicare reimbursement cuts and yet CMS proposed to extend the cuts to radiation oncology anyway.

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 support using data to ensure that payment rates for medical procedure are appropriate," said Leonard Kalman, M.D., Chairman of US Oncology's Public Policy Steering Committee. "However, making cuts of this size to radiation therapy - a treatment modality that more than 1 million cancer patients rely upon each year for both curative intent and palliative treatment - without an expressed rationale backed by supporting data is unsound and frankly quite frightening. On behalf of our country's cancer patients, many of whom will rely on radiation therapy at some point in their illness, we must ensure that these cuts are not applied."

http://www.cms.hhs.gov/