Dive Brief:
- AdvaMed has accused the Centers for Medicare and Medicaid Services (CMS) of proposing “drastic cuts” to radiotherapy reimbursement.
- The agency’s proposed physician fee schedule (PFS) includes a 2% reduction in reimbursement for radiation oncology, continuing a trend of payment cuts of more than 20% for the service over the past decade, according to the American Society for Radiation Oncology (ASTRO).
- Across all services, the CMS plans to reduce PFS payment amounts by 1.25%. The agency also hailed the draft document as advancing health equity.
Dive Insight:
The disagreement between the CMS and the organizations that provide radiation oncology equipment and services is the latest in a series of flareups between the two sides. ASTRO, which represents healthcare professionals working in radiation therapy, attacked draft proposals from the CMS in 2019 and again in 2021, accusing the centers of adopting a flawed model that limits access to cancer treatment.
Pushing back against the latest 2% reduction in the reimbursement rate for radiotherapy services, AdvaMed CEO Scott Whitaker said, “CMS is proposing to make drastic cuts that would limit access to radiotherapy treatments for an untold number of patients, especially those in rural areas of the country. At a time when this Administration is making the fight against cancer a top health priority, these cuts simply do not make sense.”
ASTRO made similar points, accusing the CMS of undervaluing the impact of radiation oncology and noting that Medicare spends more on three cancer drugs than all radiotherapy services, even as radiation oncology is used by twice as many beneficiaries. ASTRO expects the cuts to make small radiotherapy practices less viable, driving provider consolidation and forcing patients to travel further to access care.
The CMS framed the overall PFS proposal as advancing health equity and supporting the White House’s focus on accelerating the fight against cancer. AdvaMed and ASTRO think the proposal will have the opposite effect.
The CMS is expected to finalize the text in the fourth quarter and adopt the changes at the start of next year.