ASTROgram: CMS proposes significant cuts to radiation oncology reimbursement
On July 1, CMS announced proposed changes to the Medicare policies and payment rates for physician services including radiation oncology that may go into effect January 1, 2010. There are proposals within the proposed CMS regulation that will significantly impact radiation oncology reimbursement. Our preliminary analysis shows a close to 20 percent reduction to radiation oncologists' payments.
CMS believes the equipment usage assumption – part of the formula CMS uses to calculate Medicare payments – of 50 percent is significantly understated. CMS cited the March 2009 MedPac report to Congress on this issue. Therefore, within the regulation, CMS is proposing to change the equipment usage assumption from the current 50 percent usage rate to a 90 percent usage rate for equipment priced over $1 million. This proposed change will reduce payments for radiation oncology procedures, including brachytherapy, conventional 3D treatments, IMRT, SRS, SBRT and IGRT.
CMS is also proposing to use the recently collected AMA Physician Practice Information (PPI) survey data to establish Medicare payments starting January 1, 2010. The PPI survey was conducted by the AMA in conjunction with more than 30 medical specialties to collect data on physician practice expenses. Using the survey data will result in significant redistributive effects on Medicare payments. And although the radiation oncology practice expense per hour is proposed to increase from the current radiation oncology rate, a reduction in payment is scheduled.
Also within the regulation, CMS proposed to remove drugs from the SGR calculation, a big win for ASTRO and the entire house of medicine. Although CMS estimates the physician update will result in a calendar year 2010 conversion factor of $28.3208 and a PFS update of –21.5 percent, this action will substantially reduce the legislative cost of congressional proposals to reform physician payments and lessen the forecast SGR cuts in future years.
These proposed reductions in radiation oncology Medicare payments are not appropriate or sustainable. ASTRO will work to prevent these dramatic cuts from being implemented January 1, 2010. ASTRO will conduct a complete analysis of the regulations and provide a more detailed analysis to ASTRO members. A rule briefing will also be held for ASTRO members in early August. If you have any questions, please contact the ASTRO Health Policy Department by e-mail or at 1-800-962-7876.
