Radiation therapy 'under attack' from CMS cuts, professional body warns

Dive Brief:

Patient access to radiation therapy is "under attack" from incoming Medicare payment cuts, the body that represents healthcare professionals working in the space alleged this week.
CMS proposed changes to its radiation oncology model earlier this week as a result of the pandemic-driven delay in its implementation. The American Society for Radiation Oncology said CMS is proceeding with $160 million in reductions through the model.
ASTRO is calling for President Joe Biden to "immediately intervene" on the "flawed" model and proposed Medicare Physician Fee Schedule cuts.

Dive Insight:

ASTRO is a long-standing critic of the radiation oncology model proposed by CMS. The aim of the model for the agency is to enhance the quality of care received by Medicare beneficiaries while reducing or maintaining spending. Through the model, CMS wants to assess if "site-neutral, modality agnostic, prospective episode-based payments" for radiation therapy episodes achieve those dual objectives.

In 2019, ASTRO estimated that CMS' draft proposal would cut payments to required participants by $320 million over a five-year period. ASTRO called the cuts "excessive." However, CMS pushed ahead with the core of its draft proposal and issued a final rule in September 2020.

COVID-19 and the Consolidated Appropriations Act, 2021 pushed the start date back from January 2021 to January 2022. This week, CMS used the delay to propose modifications including the resetting of the baseline period and revisions to the cancer inclusion criteria. The changes did not address ASTRO's concerns.

"CMS is jeopardizing the ability of the nation's radiation therapy professionals to continue to provide essential care for their patients now and in the future. Access to life-saving cancer treatments will suffer, and the viability of clinics already reeling from the pandemic will be at considerable risk if these proposals are finalized," ASTRO chair Thomas Eichler said in a statement.

The concerns of Eichler, the medical director, radiation oncology at Thomas Johns Cancer Hospital, go beyond the radiation therapy model. To Eichler, the update to the payment model is the second blow to radiation therapy in quick succession.

Last week, CMS proposed the Medicare Physician Fee Schedule for 2022. ASTRO estimates the new schedule will cut radiation oncology services fees by 8.75%. Most of the reduction stems from rises in clinical labor pricing the group contends "has the effect of lowering payments to specialties that use expensive equipment, such as radiation oncology." Cuts for some services could be as deep as 22%.

ASTRO is pushing for Biden and Congress to intervene. The professional body wants to reform the radiation oncology model and at least have the physician fee schedule cuts phased in over time.

Cowen analysts have said Accuray has viewed the value-based plan as a net positive for its business, while equipment manufacturers including Varian, ViewRay and Hitachi have expressed concerns. Siemens and Elekta are among companies that could also be affected by the reimbursement changes.