Centers for Medicare & Medicaid Services Releases 2016 Medicare Physician Fee Schedule: Impact on Radiation Oncology

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The final 2016 Medicare Physician Fee Schedule released October 30, 2015, by the Centers for Medicare & Medicaid Services (CMS) included cuts to radiation oncology clinics that were slightly less severe than anticipated, according to a news release issued by the American Society for Radiation Oncology (ASTRO). The final rule reduced physician payment rates by 2% for the radiation oncology specialty in general. CMS scaled back reductions initially proposed in July 2015.

The impact of the final rule on community-based radiation therapy centers, including those in rural and medically underserved areas, will vary based on their patient and modality mix. Although reductions specific to these practices were less than those proposed in July, uncertainty remains as to the viability of freestanding clinics given the potential for more substantial cuts to accompany the future implementation of new codes. The 2016 reductions compound preexisting reimbursement cuts of more than 20% to freestanding clinics in the past 6 years.

Advocacy Campaign

The final rule comes after a comprehensive advocacy campaign led by ­ASTRO. In September, 207 members of Congress representing both chambers and both major parties signed letters to CMS articulating serious concerns with the proposed cuts to radiation oncology and urging CMS to avoid imposing barriers to patient care. The effort, led by Senators Richard Burr (R-North Carolina) and Debbie Stabenow (D-Michigan) and Representatives Devin Nunes (R-California) and Paul Tonko (D-New York), called particular attention to the burden that community-based clinics would face by losing the payment stability, which is essential to ensure accessible, affordable care for their patients.

“We appreciate the work of our Congressional partners in protecting patient access to radiation oncology care and helping avert more drastic cuts,” said Bruce D. Minsky, MD, FASTRO, Chair of ASTRO’s Board of Directors. “ASTRO will continue urging CMS to heed the call from Congress to end the uncertainty and instability facing radiation therapy practices and their patients.”

A July 2015 survey conducted by ­ASTRO of the nearly 1,400 community-based radiation therapy centers in the United States found that cuts of 5% to 10% could cause nearly 30% of these practices to close. More than 40% of respondents said such cuts would force them to discontinue accepting patients covered by Medicare, and more than 60% reported they would have to consolidate practice locations.

In scaling back the proposed cuts, CMS said it will delay the implementation of new conventional radiation oncology, intensity-modulated radiation therapy, and image-guided radiation therapy codes and retain the G-codes created as placeholders for deleted predecessor codes in the 2015 final rule for another year.

Changes in allowed charges and payment rates will take effect on January 1, 2016. ■




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