Centers for Medicare and Medicaid Services imposes cuts to radiation oncology clinics that may limit patient access to care
Changes in 2016 Medicare Physician Fee Schedule spell modest reimbursement reductions for radiation oncology clinics
The final 2016 Medicare Physician Fee Schedule (MPFS) released Friday by the Centers for Medicare and Medicaid Services (CMS) included cuts to radiation oncology clinics that were slightly less severe than anticipated. The final rule reduced physician payment rates by two percent for the radiation oncology specialty in general. CMS scaled back reductions initially proposed in July.
The impact of the final rule on community-based radiation therapy centers, including those in rural and medically underserved areas, will vary based on their patient and modality mix. Although reductions specific to these practices were less than those proposed in July, uncertainty remains as to the viability of freestanding clinics given the potential for more substantial cuts to accompany the future implementation of new codes. The 2016 reductions compound pre-existing reimbursement cuts of more than 20 percent to freestanding clinics in the last six years.
The final rule comes after a comprehensive advocacy campaign led by the American Society for Radiation Oncology. In September, 207 members of Congress representing both chambers and both major parties signed letters to CMS articulating serious concerns with the proposed cuts to radiation oncology and urging CMS to avoid imposing barriers to patient care. The effort, led by Sens. Richard Burr (R-N.C.) and Debbie Stabenow (D-Mich.), and Reps. Devin Nunes (R-Calif.) and Paul Tonko (D-N.Y.) called particular attention to the burden that community-based clinics would face by losing the payment stability that is essential to ensure accessible, affordable care for their patients.
“We appreciate the work of our Congressional partners in protecting patient access to radiation oncology care and helping avert more drastic cuts,” said Bruce D. Minsky, MD, FASTRO, Chair of ASTRO’s Board of Directors. “ASTRO will continue urging CMS to heed the call from Congress to end the uncertainty and instability facing RT practices and their patients.”
A July 2015 survey conducted by ASTRO of the nearly 1,400 community-based RT centers in the U.S. found that cuts of five to 10 percent could cause nearly 30 percent of these practices to close. More than 40 percent of respondents said such cuts would force them to discontinue accepting patients covered by Medicare, and more than 60 percent reported they would have to consolidate practice locations.
In scaling back the proposed cuts, CMS said it will delay implementation of the new conventional radiation oncology, intensity-modulated radiation therapy (IMRT), and image-guided radiation therapy (IGRT) codes and retain the G-codes created as placeholders for deleted predecessor codes in the 2015 final rule for another year. The final rule unfortunately also increases the equipment utilization rate assumption for clinics’ linear accelerator machines from 50 to 70 percent by 2017.
The MPFS sets 2016 Medicare payment rates and policies for services performed in both freestanding clinics and hospital outpatient clinics. This final rule determines professional payment rates for services performed in both environments, as well as technical payments for freestanding clinics. Changes in allowed charges and payment rates will take effect on January 1, 2016.
Erin L. Boyle
ASTRO is the premier radiation oncology society in the world, with nearly 11,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy. ASTRO publishes three medical journals, International Journal of Radiation Oncology • Biology • Physics (www.redjournal.org), Practical Radiation Oncology (www.practicalradonc.org) and Advances in Radiation Oncology (www.advancesradonc.org); developed and maintains an extensive patient website, www.rtanswers.org; and created the Radiation Oncology Institute (www.roinstitute.org), a non-profit foundation to support research and education efforts around the world that enhance and confirm the critical role of radiation therapy in improving cancer treatment. To learn more about ASTRO, visit www.astro.org.