On July 3, 2014, the Centers for Medicare and Medicaid Services (CMS) proposed rates for the 2015 physician fee schedule that would have cut radiation oncology payments by 4 percent and community-based radiation therapy centers by 6 to 8 percent. The proposal most significantly impacting radiation oncology would have removed the radiation treatment vault as a direct practice expense input from radiation treatment procedure codes. On October 31, CMS announced that they would not be implementing these cuts.
The American Society for Radiation Oncology (ASTRO) strongly fought against these changes as detrimental for patient access to radiation therapy. They applauded CMS’ decision and also thanked radiation oncology’s congressional champions for working with CMS to protect cancer patients’ access to radiation therapy across the country. More than 160 bipartisan Senators and Representatives, led by Sens. Debbie Stabenow (D-Mich.) and Richard Burr (R-N.C.), as well as Reps. Joe Pitts (R-Penn.), Frank Pallone (D-N.J.), Devin Nunes (R-Calif.) and Gary Tonko (D-N.Y.), agreed with ASTRO and sent several letters in September 2014 to CMS expressing serious concerns about the proposed Medicare payment cuts.
Many commentators also responded to CMS. They reiterated their rationale for inclusion of the radiation treatment vault as a direct practice expense input, asserting that the vault is necessary for the functioning of the equipment, serves a unique medical need, cannot be separated from the treatment delivered by the linear accelerator, and cannot be repurposed for another use.
CMS took note of the effort. Their 2015 fee schedule final rule states that CMS will delay its decision for one year regarding classification of the radiation treatment vault because the issue needs detailed study and evaluation. In addition, CMS has delayed implementation of new radiation treatment delivery codes until 2016. For 2015, CMS will continue to use 2014 price inputs, however, reimbursement rates may change. Since some 2014 treatment codes were deleted, CMS will create G-codes as necessary to allow for reporting these services in 2015. The agency said it will pay for the G-codes the same way it did for the predecessor codes in 2014.
ASTRO’s Press Release highlights their success:
“ASTRO greatly appreciates federal policymakers’ attention to the importance of preserving patients’ access to radiation oncology services,” said Bruce G. Haffty, MD, FASTRO, chair of ASTRO’s Board of Directors. “As CMS reconsiders these issues next year, we look forward to working with the agency and Congress to end the instability in reimbursement for community-based radiation therapy centers so we can ensure that patients and their treatment team can focus on what’s most important: curing their cancer. We are extremely grateful to several congressional leaders, particularly Sens. Stabenow and Burr, as well as Reps. Pitts, Pallone, Nunes, Tonko, for their commitment and tireless work to support radiation oncology and the life-saving care we provide to more than one million cancer patients.”