Oncology centers say CMS payment model would discourage use of new technology

Doctor with inpatient
Oncology centers are not happy with the Centers for Medicare & Medicaid Services' proposed, mandatory five-year payment model to bundle radiation therapy services. (Getty/Ridofranz)

Oncology centers say a Trump administration proposal to bundle Medicare payments for radiation therapy will discourage providers from using new technology.

Comments on the proposed five-year model from the Centers for Medicare & Medicaid Services (CMS) ended Monday. Several organizations said the proposed model would severely cut payments for a new type of radiation treatment.

The proposed payment model would pay a physician or radiation therapy center for select services over a 90-day period. The payment wouldn’t cover the total cost of all care provided to the beneficiary, but rather cover only select services such as dose planning, CT simulations and treatment aids.

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The goal of the mandatory model is to address perverse incentives for providers to select a treatment plan for a patient that includes a high volume of services, even if they are not medically necessary, according to the proposed rule released in July.

“This structure may incentivize providers and suppliers to furnish longer courses of (radiation therapy) because they are paid more for furnishing more services,” the rule said. “Importantly, however, the latest clinical evidence suggests that shorter courses of (radiation therapy) for certain types of cancer would be equally effective and could improve the patient experience, potentially reduce costs for the Medicare program and lead to reductions in beneficiary cost-sharing.”

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The new model would go into effect Jan. 1, 2020, but CMS is considering delaying implementation until April to give companies more time. The model would also apply a “site-neutral” test to the payments to ensure the reimbursement is the same no matter where the care is delivered.

But oncologists, free-standing oncology centers and other providers were livid that the model would reimburse proton beam therapy at the same rate as other types of radiation treatment, even though proton therapy costs more.

Proton therapy treats cancer using protons instead of X-rays employed by traditional radiation therapy. But proton therapy is relatively new and costly for providers to administer. Under the proposed model, oncologists would get reimbursed less for turning to the therapy.

“By establishing payment rates that reimburse all modalities the same, CMS, by its own logic, is financially incentivizing providers to use the cheapest modalities which also tend to be those that deposit the greatest amount of radiation in healthy tissue,” said the nonprofit Provision CARES Proton Therapy centers located in Knoxville and Orlando. “This entirely ignores side effects and potential secondary cancer profiles, running afoul of the desire to improve quality and patient care.”

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The New York Proton Center added in comments that proton therapy can reduce costly long-term complications. However, the payment model discourages the use of the new technology, the center added.

Several oncology centers also complained that the five-year model will be mandatory.

“Requiring a random 40% of radiation oncology practices to participate is unprecedented,” said the Las Vegas Prostate Cancer Center in comments. The center wanted CMS to make four years of the model voluntary and then install a “limited mandatory model which would include exemptions for hardships and low volume practices.”

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