Medicare plans to cut RO reimbursement by 14%

[Taurus]

You guys have to realize that rad-onc is in the crosshairs of CMS no matter if the cuts are somehow delayed. CMS tried to cut rad-onc reimbursements last year but backed down after lobbying. Guess what? CMS is trying it again this year and most likely will get it. If not this year, then next year. They won't stop until they get what they want.

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[thesauce]

You guys have to realize that rad-onc is in the crosshairs of CMS no matter if the cuts are somehow delayed. CMS tried to cut rad-onc reimbursements last year but backed down after lobbying. Guess what? CMS is trying it again this year and most likely will get it. If not this year, then next year. They won't stop until they get what they want.

I'm not sure why you think this is an important point. Cuts are coming for every specialty. Do you think specialties should just give up and let it happen because it will happen eventually anyway? They will try it every year and we will fight it every year. Delaying these cuts is a huge victory and all anyone is trying to achieve.

 

[Mandelin Rain]

For what it's worth, it does appear that IMRT/SBRT reimbursement will be cut by 15 to 19% for free standing radiation oncology clinics/physicians despite the best efforts of ASTRO.

 

[Gfunk6]

Well, we'll see what happens. For now I choose to remain cautiously optimistic.

 

[BraggPeak]

For what it's worth, it does appear that IMRT/SBRT reimbursement will be cut by 15 to 19% for free standing radiation oncology clinics/physicians despite the best efforts of ASTRO.

What are you basing this on?

 

[medgator]

What are you basing this on?

Yeah I was wondering the same thing.

 

[TarHeelRadOnc]

Yeah I was wondering the same thing.

Me three

 

[Gfunk6]

So I was perusing the Winter 2012 "ASTRO News" and saw the 2013 Medicare Physician Fee schedule.

The biggest reimbursement drops for photons were:

77014 (basically IGRT using CT scans) by 13%
77418 (daily IMRT charge) by 15%

However, protons got HAMMERED!

77253 (Proton treatment intermediate)
77525 (Proton treatment complex)
both took a 56% cut!

Overall there was an estimated 6% cut to Rad Onc.

 

[RadRadRad]

maybe next year we can get them focused on neutrons...that could save us all for a couple more years (sorry UW). Someone start working on a JAMA article showing no benefit to neutrons.

 

[medgator]

However, protons got HAMMERED!

77253 (Proton treatment intermediate)
77525 (Proton treatment complex)
both took a 56% cut!

At least CMS keeps abreast of the recent proton literature wrt mainstream non-peds/CNS indications.

I wonder how many planned facilities will be scuttled because of this (or shut down in some cases).

 

[Reaganite]

So I was perusing the Winter 2012 "ASTRO News" and saw the 2013 Medicare Physician Fee schedule.

The biggest reimbursement drops for photons were:

77014 (basically IGRT using CT scans) by 13%
77418 (daily IMRT charge) by 15%

However, protons got HAMMERED!

77253 (Proton treatment intermediate)
77525 (Proton treatment complex)
both took a 56% cut!

Overall there was an estimated 6% cut to Rad Onc.

Yeah, I'm still trying to find out why "complex" got cut but "simple" proton reimbursement stayed the same. from what I've been told many proton centers code prostate treatments as simple. this being said, it appears there will be even less of an incentive to treat complex pediatric cases now.

 

[RadOncDoc21]

maybe next year we can get them focused on neutrons...that could save us all for a couple more years (sorry UW). Someone start working on a JAMA article showing no benefit to neutrons.

Hyperthermia may be the way to go in the future. On another note, I don't get why cardiothoracic surgeons get to bill for SBRT.

 

[temujim]

Hyperthermia may be the way to go in the future. On another note, I don't get why cardiothoracic surgeons get to bill for SBRT.

My guess is CMS wants to incentivize CT surgeons not to do surgery.

 

[Reaganite]

I don't know the veracity of this but I heard that some of the proton cuts were based on data that was botched. Not sure the whole story behind this, maybe someone more in the know can fill us in.

I heard through the grapevine it had something to do with the way UPenn was coding prostates. I think they were coding them as "complex" cases. But don't quote me on this...

 

[Gfunk6]

Hyperthermia may be the way to go in the future. On another note, I don't get why cardiothoracic surgeons get to bill for SBRT.

Hyperthermia reimbursement is horrible and the handful of medical centers that have the capability frequently have to fight to get paid.

Yeah, I'm still trying to find out why "complex" got cut but "simple" proton reimbursement stayed the same. from what I've been told many proton centers code prostate treatments as simple. this being said, it appears there will be even less of an incentive to treat complex pediatric cases now.

That's very interesting and tragic, if true.

 

[Seldon1985]

I heard through the grapevine it had something to do with the way UPenn was coding prostates. I think they were coding them as "complex" cases. But don't quote me on this...

Heard the same thing...that they were coding most cases as 'complex' without a full understanding. They apparently did admit the error but that didn't stave off cuts. I've heard that centers still negotiate fees and some are more successful than others... My understanding of this process is very elementary though...

 

[Gfunk6]

There is a nice study looking at the financial solvency of proton beam therapy in the latest Red Journal, co-authored by MGH and IU. The study looks at projected revenue as a result of the Affordable Care Act (Obamacare).

They divide proton beam cases as follows:

1. Complex - pediatrics +/- anesthesia - 1 hour of machine time
2. Simple - H&N, pelvis - 30 min of machine time
3. Prostate - 24 minutes of machine time
4. "Short" prostate - 10 minutes of machine time

Here is the first paragraph of the discussion section:

Discussion

We found that changes in reimbursement associated with the Affordable Care Act could reduce daily revenues for PBT facilities by up to 32% and that facilities focusing primarily on noncomplex cases would suffer the largest relative losses. The incremental revenue gained by treating noncomplex cases in lieu of more time-consuming treatments would be reduced by 41% to 59% after ACO rates. However, at interest rates above 5% or capital costs exceeding $175,000,000, centers would need to treat even larger numbers of noncomplex cases simply to cover daily principal and interest payments. As a result, reimbursement rates after reform would only decrease the maximum percentage of complex patients that 4 gantry facilities were able to treat, by up to 26% of their total census. Assuming that centers are able to operate at full capacity, our models indicate they would have to operate at 18 hours per day simply to cover daily debt payments over a wide range of reasonable debt scenarios.

Of course, these are "projections" so the usual caveats apply but I'm glad to have read this analysis.