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CMS Changes to Physician Fee Schedule Face Resistance From Radiation Oncologists

Surabhi Dangi-Garimella, PhD
With the comment period ending today, the proposed CMS cuts to radiation oncology reimbursement rates might have a substantial impact on community treatment centers.
The comment period for the Medicare Physician Fee Schedule (MPFS) for the year 2016 ends today and physicians have not held back in expressing concerns and their opposition to some of the provisions within the MPFS. The main opposition comes from community oncology centers and freestanding cancer care facilities who would have the most impact of the proposed cuts. According to the proposal, there would be a 3% reduction in payments to the overall radiation oncology specialty, although the cuts would vary depending on the patient population and could even reach 10%.

Some of the proposed changes by CMS for radiation oncology include:

·         The implementation of new treatment delivery codes which were delayed in the CY 2016 PFS Final Rule as well as CMS modifications to those codes

·         CMS's proposal to increase the equipment utilization assumption for the linear accelerator from 50% to 70%

·         Corresponding increases in other radiation oncology codes due to an increase in the indirect practice cost index.

Immediately following the proposed policy and payment changes, The American Society for Radiation Oncology (ASTRO) issued a press release expressing concern over the cuts. “The implementation of these three dramatic policy changes at once represents too much, too fast for community-based clinics to absorb and could have devastating effects, particularly for those centers in rural and underserved areas,” said ASTRO chair Bruce G. Haffty, MD, FASTRO, in the release.

In a related blog on The Hill, Christopher M. Rose, MD, chief technology officer at Vantage Oncology, Inc—a coalition of 296 freestanding cancer care facilities across 35 states—writes that the proposed changes could have devastating effects on care delivery and patient access, especially the more vulnerable populations.  “If the proposed PFS changes were adopted, the payments for a course of care for prostate and breast cancer will be reduced by 25% and 19%, respectively. Furthermore, this same care will be reimbursed 36% less and 32% less, respectively, in the freestanding setting than care delivered in the hospital setting,” he writes.

The final rule is expected to be issued by November 1, 2015 and the ruling will be effective January 1, 2016.

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