CMS FINAL RULE (OCTOBER '09)
On October 30, 2009, the Centers for Medicare & Medicaid Services (CMS) published the final rule for the 2010 Medicare Physician Fee Schedule. As part of the final rule, CMS announced that it was not implementing the changes in utilization rate assumption for radiation therapy equipment that CMS had included in its July 2009 proposed Revisions to Payment Policies Under the Physician Fee Schedule and Part B for CY 2010. If this change had been finalized, it would have resulted in radiation therapy reimbursement cuts of over 44 percent, compromising access to care for cancer patients across the country. In deciding not to finalize its proposal to increase the utilization rate assumption for radiation therapy equipment, CMS cited many of the specific arguments AICC had presented as part of its comprehensive comments to CMS.
AICC's survey of physician practices across the country illustrated vividly the dramatic impact that the CMS policy changes, if finalized, would have had on physician practice operations and the ability of patients to access treatment critical to their lives, particularly in rural areas. In its final rule, CMS noted that commenters had pointed out that "our proposal would create access issues, especially in rural areas."
AICC's written comments to CMS also highlighted the fact that CMS' proposed policies did not comply with statutory mandates that require CMS to obtain data regarding actual equipment utilization and to consult with physician organizations regarding the methodology and data to be used. In simply extrapolating MedPAC's recommendations regarding diagnostic imaging to all equipment priced at more than $1 million, AICC noted that CMS had not complied with either requirement. In its final rule, CMS acknowledged this precise argument and stated that "we are persuaded... that the extrapolation of the MRI and CT [utilization] data to all expensive equipment may be inappropriate..."
AICC's Congressional advocacy resulted in strong communications advising CMS not to finalize the proposed changes in the physician fee schedule as applied to radiation therapy. Congressman Gregory Meeks (NY) led a letter to CMS signed by seven other Congressional Black Caucus Members noting that the CMS proposed payment change was astounding given the impact on African American men "for whom a significant disparity continues to exist in the incidence and mortality of prostate cancer as compared to American men generally." Congressman Meeks has long promoted additional funding for research, educational awareness, and early detection for prostate cancer in African American men. Identifying the impact CMS' proposed cuts would have on the African-American population, which would be particularly vulnerable if access to care was compromised, was a perspective that CMS had not otherwise heard. House Cancer Caucus Co-Chair Steve Israel (NY) and Charles Gonzalez (TX) led another letter at AICC's request urging CMS not to expand the MedPAC equipment utilization assumption beyond diagnostic imaging, particularly as it affects radiation oncology. The political support was essential in bringing attention to the legal and policy arguments raised in AICC's written submission to CMS and September face-to-face meeting with CMS management who craft the physician fee schedule.
CMS' decision not to finalize the change in utilization rate assumption for radiation therapy equipment represents an enormous victory for those who seek to preserve access to high quality, integrated cancer care throughout the country.
To review the portion of the Medicare Physician Fee Schedule for CY 2010 regarding equipment utilization rate,
click here.
To review the Medicare Physician Fee Schedule for CY 2010 in its entirety,
click here.
