Radiation Oncologists Met With Congressional Leaders to Reverse CMS Cuts and Provide Equal Access to Care

Radiation oncologists met with Congress to urge leaders to consider how the Medicare and Medicaid Services (CMS) proposal to make significant cuts to radiation oncology facilities could be detrimental to the survival of patients with cancer, according to a press release from the American Society for Radiation Oncology (ASTRO).¹

In 2021, 1.9 million people are anticipated to be diagnosed with cancer. This adds to an increasing number of late-stage cancer diagnoses caused by numerous delays in cancer screenings and detection due to the COVID-19 pandemic. This has led to a need for an "all doors open" treatment strategy in order to manage the increased number of patients with late-stage disease.

Over 100 oncologists met with medical physicists from 32 states and participated in 150 virtual meeting with lawmakers to emphasize the importance of keeping these facilities open. Oncologists noted 3 important points as to why the facilities need to remain open:

First, oncologists noted the importance of defending equitable access to care by reforming the Radiation Oncology Model and stabilizing Medicare rates. In September of 2020, the CMS proposed the creation of a Radiation Oncology Alternative Payment Model (RO Model) by January 2022.² Further changes to the RO model were proposed on July 19, including slight revisions to the discount factor without addressing numerous concerns raised by both the radiation oncology community and a broad coalition of medical provider groups, patients, hospitals, health systems, and bipartisan members of Congress.

The community is anticipating notable reductions in the RO model due to Hospital Outpatient Prospective Payment System (HOPPs) rules and proposed cuts from the 2022 Medicare Physician Fee Schedule (MPFS), which led to a 8.75% cut to radiation therapy services that will largely affect rural and underserved communities, thus enabling further healthcare disparities. The cuts could lead to a 17% decline in physician reimbursement over the last decade, as well as a 22% reduction in high-value radiation treatment reimbursements.

ASTRO is requesting that the CMS reduce payment cuts or at least phase in reductions in order to preserve access to radiation oncology services and protect the financial viability of smaller practices. Additionally, the organization proposed a Health Equity Achievement in Radiation Therapy (HEART) payment in order to cover patient care navigation, which can help to manage healthcare disparities; this is not currently covered in Medicare fee schedules.

“CMS has singled out radiation oncology for payment cuts that put access to cancer care for Medicare beneficiaries in peril. By proposing to cut high-value radiation treatments by as much as 22% and proceeding with more than $160 million in reductions under the RO model, [the] CMS is jeopardizing the ability of the nation’s radiation therapy professionals to continue to provide essential care for their patients now and in the future," Thomas J. Eichler, MD, FASTRO, chair of the ASTRO Board of Directors, said in a press release.

Oncologists also emphasized the benefit of reducing prior authorization. In a survey that was conducted by ASTRO in August 2018 findings indicated that these authorizations are the greatest challenges in the field.³ During the pandemic, oncologists reported that prior authorizations worsened, and cancer treatment delays went up by 64%. Additionally, 66% of oncologists reported that their patients suffered negative results due to these delays. Moreover, a separate study that was conducted by Plos One indicated that each week of delayed treatment was associated with a 1.2% to 3.2% increase risk of cancer death.⁴

Lastly, oncologists emphasized the importance of advocated for increased cancer research federal funding. Due to the pandemic, previous support for cancer research was upended due to the freeze on clinical trials and labs being closed. These elements resulted in an increase in cancer cases and deaths due to lapsed screening and availability to treatments. ASTRO emphasized the need for Congress to respond to the increased incidence of cancer with additional funding for various facilities such as National Institutes of Health and National Cancer Institute.

References:

1. Radiation oncologists urge Congress to reverse proposed CMS cuts and create more equity in access to cancer treatments. News Release. ASTRO. July 26, 2021. Accessed July 27, 2021. https://bit.ly/3rBYPJu

2. Radiation oncology alternative payment model (RO Model). Press Kit. ASTRO. Accessed July 27, 2021. https://bit.ly/3i4EERp

3. Prior authorization obstacles to cancer patient care. Press Kit. ASTRO. Accessed July 27, 2021. https://bit.ly/3740UVm

4.Khorana AA, Tullio K, Elson P, et al. Correction: time to initial cancer treatment in the United States and association with survival over time: an observational study. PLoS One. 2019;14(4):e0215108. doi:10.1371/journal.pone.0215108