Radiation oncologists could see a nearly 15% cut to their payments under the proposed 2013 Medicare Physician Fee Schedule.
About half of the planned cut is as a result of changes in the way the Medicare calculates the time involved in performing intensity-modulated radiation treatment (IMRT) delivery and stereotactic body radiation therapy (SBRT) delivery. Using patient education materials published by leading medical societies, officials at the Centers for Medicare and Medicaid Services determined that they were paying too much for IMRT and SBRT because these services don’t take as long to perform as had previously been calculated.
For example, the current CPT code for IMRT treatment delivery (77418) is based on an assumption that the procedure will take 60 minutes to perform. However, information from patient fact sheets showed a significantly faster procedure time. As a result, the CMS is proposing to base payment on a procedure time of 30 minutes.
For SBRT treatment delivery (CPT code 77373), the current procedure time assumption is 90 minutes. The proposed procedure time assumption is 60 minutes, based on publicly available patient education materials.
The CMS reviewed the procedure time assumptions associated with IMRT and SBRT as part of an overall review of potentially "misvalued" codes.
Officials at ASTRO (American Society for Radiation Oncology), which represents radiation oncologists, criticized the proposal, saying that it would curb patient access to treatment, particularly in rural communities. They pointed to the preliminary results of a member survey that showed that some radiation oncology practices may be forced to close, while others would delay the purchase of new equipment, lay off staff, or limit the new Medicare patients they treat.
The organization also took issue with the process the CMS used in evaluating the procedures.
"ASTRO believes that [the CMS] should utilize the rigorous processes and methodologies already in place and utilized for the past 20 years to set reimbursement rates," Dr. Leonard L. Gunderson, chairman of ASTRO’s Board of Directors, said in a statement.
Dr. Gunderson said that ASTRO would like to see a comprehensive review of treatment costs through the American Medical Association’s Specialty Society Relative Value Scale Update Committee (RUC), a panel of 31 physicians who offer advice to the CMS on how to value physician services.