^

ASTRO Blog

ASTRO Blog

ASTRO Advocacy Ramps Up To Thwart Medicare Double Whammy

By William Hartsell, MD, FASTRO, Chair, ASTRO Health Policy Council and Howard Sandler, MD, MS, FASTRO, Chair, ASTRO Government Relations Council

On April 28, 2021, President Joe Biden declared in his State of the Union address a commitment to “end cancer as we know it,” a goal ASTRO strongly supports. Sadly, three months later, the Centers for Medicare and Medicaid Services (CMS) unveiled two policy proposals that threaten to end radiation oncology as we know it. ASTRO was prepared for the possibility of Medicare payment cuts and is rolling out a comprehensive advocacy strategy to combat these flawed policies.

Medicare is planning a draconian double whammy for radiation oncology payments starting in 2022, with significant payment cuts totaling $300 million under the Medicare Physician Fee Schedule ($140 million) and Radiation Oncology Model ($160 million). ASTRO believes these cuts contradict the president’s anti-cancer goals as well as initiatives to advance health equity. Instead, these excessive cuts will jeopardize cancer patients’ ability to receive state-of-the-art care close to home. ASTRO is disturbed that practices treating rural and underserved populations will be hit hardest, limiting their ability to provide critical services to their patients and possibly forcing patients to travel long distances for treatment.

The facts are grim. If the Physician Fee Schedule cuts are finalized, payments to radiation oncology will have plummeted by 25% since 2012. The cuts proposed for 2022 for radiation oncology are among the highest of any medical specialty, with some key services dropping by as much as 22%. This follows on radiation oncology revenues dropping by 8% in 2020, according to an American Medical Association analysis, as clinics now try to recover while treating patients with more advanced disease that require more complex and costly treatments.

Meanwhile, the Radiation Oncology Model (RO Model) discount factor payment cuts are out of step with other alternative payment models and will put practices that are required to participate in jeopardy. Combined, the constant, year-after-year threats to clinics’ financial viability and out of control administrative burden will further contribute to burnout among physician staff.

ASTRO is sounding the alarm on the impact these cuts will have on cancer patient care. ASTRO’s Health Policy Council and Government Relations Council leadership, in concert with the ASTRO Board of Directors, is focused on dramatically scaling back the cuts stemming from both the fee schedule and RO Model and has developed an advocacy plan of action. The multipronged advocacy strategy will be in high gear through the end of the year and likely beyond. It’s important that members know some of the key features of that strategy so they can actively participate in stopping the cuts.

ASTRO is directly engaging President Biden and White House officials, with the goal of applying significant pressure on CMS to reverse course. In July, ASTRO sent a strong letter to President Biden and his senior staff and is following up with high-level meetings on the collective threats of the RO Model and fee schedule cuts. ASTRO already has secured numerous media reports highlighting for Biden Administration leadership the severity and impact of the payment cuts, and more public relations outreach is in the works.

ASTRO’s health policy team is engaged in extensive policy and data analysis to identify changes that must be made to the RO Model and fee schedule to protect access to radiation therapy. We’re working closely with partners in the House of Medicine on official comment letters to influence CMS.

To further influence the regulatory process, ASTRO’s government relations team is reaching out to congressional champions to contact CMS and demand changes that finally correct the RO Model and hold radiation oncology harmless from fee schedule payment shifts unrelated to radiation oncology. ASTRO has been working with legislators in the event congressional oversight is needed, and this initiative jumpstarted during Advocacy Day in late July when 100 ASTRO members met with 160 congressional offices on the proposed cuts.

ASTRO members should be on the lookout for action alerts in the coming weeks that will encourage radiation oncology team members to directly engage in grassroots efforts to urge members of Congress to support the specialty against the cuts. But there’s no need to wait, as senators and representatives are in their home states and districts for August recess and looking to meet with their constituents ― you!

ASTRO advocacy volunteers and staff will spend the next several months aggressively executing this strategy, recognizing it will be a great challenge to force CMS to change course. Therefore, ASTRO is preparing for the potential that legislative relief will be necessary before the end of the year.

For every aspect of the advocacy strategy, ASTRO is working closely with a committed group of radiation oncology stakeholders representing health professionals, patients, hospitals, office-based clinics, device manufacturers and more. We appreciate the hard work and support of our members and partners, as a unified and devoted team is essential for success against this dire threat.

Posted: August 17, 2021 | 0 comments


What Comes Next: Advocacy in 2021

By Casey Chollet, MD, Government Relations Committee Chair

2020. By any standard, it was a year to remember...and forget. The COVID-19 pandemic took hold over almost everyone’s energy and focus, sidelining so many routine things we previously took for granted. While the public health emergency rightly became the primary focus of our medical community, the radiation oncology field continued to face direct challenges and looming burdens on the congressional horizon. Be it the threat of a flawed RO Model, payment cuts in the 2021 Medicare Physician Fee Schedule (MPFS) or the progressive burdens of prior authorization, the ASTRO Advocacy team continued to fight for relief throughout the year.

Ultimately, 2020 closed with many victories for our community. The RO Model was delayed until at least January 2022, saving participants approximately $45 million in 2021. Payment cuts in the 2021 MPFS were significantly reduced, protecting radiation oncology from another $100 million in losses in 2021. And prior authorization reform legislation received the support of more than 280 bipartisan co-sponsors in the House, as well as a companion bill introduced in the Senate. On top of these radiation oncology victories, COVID-19 support was secured in the form of continued funding for the Provider Relief Fund that helped offset revenue declines triggered by the reduction of in-person care visits and cancer screenings.

These victories were possible only because of close collaboration between ASTRO Advocacy and our members, and strengthening this collaboration is critical to making 2021 even more successful for radiation oncology. Whether it be through participating in Advocacy Day or email advocacy campaigns, increased engagement by our membership is critical to success.

For instance, ASTRO staff lobbyists and Najeeb Mohideen, MD, FASTRO, teamed up to keep Rep. Raja Krishnamoorthi (D-IL), Dr. Mohideen’s congressman, informed about RO Model concerns. In response, Rep. Krishnamoorthi joined his colleagues in writing the HHS Secretary at the time, Alex Azar, about the need for reforms.

In 2020, ASTRO members sent over 3,200 messages to their representatives and senators advocating for our specialty: that’s almost nine messages a day! Rising to the challenge of the COVID era, 69 members participated in a virtual Advocacy Day on the Hill, attending over 90 meetings. But despite these impressive efforts, our specialty must do more to achieve our long-term policy goals. If we were able to make such a big impact in 2020 with a relatively small level of member participation, just think of the positive changes we can bring about by making our unified voice that much louder. Meaningful prior authorization reform, a viable value-based payment opportunity and sustained investment into cancer research are all possible, but they rely on your action.

Engaging your representatives and senators on these issues is easier than ever, and I encourage you to take advantage of every opportunity to support our policy goals. Write letters, send emails and engage leaders on social media. And if COVID-19 trends continue to improve in your community, please consider inviting them to visit your treatment facilities.

So, keep an eye out for those action alerts and ASTROgram stories, and be sure to check astro.org/advocate regularly. Every effort you make is another step toward improvements for our patients and our community.

Posted: April 20, 2021 | 0 comments


Prior Authorization: Denial by delay

By Vivek Kavadi, MD

"Honestly, why do you need prior authorization for my cancer treatment? It is not elective!" This comment from one of our radiation patients represents the frustrations of many patients across the country. As vice-chair of the Payer Relations Subcommittee (PRC), I frequently receive complaints from ASTRO members about the negative effects that the prior authorization process has on their practice and their patients. In the recent ASTRO Prior Authorization Survey, an overwhelming majority of respondents reported that their patients experience delays in care. Nearly three quarters of these radiation oncologists also said that their patients regularly express concern over these delays.

I work in a cancer center where the radiation treatment area is in the same location as chemotherapy infusion. This provides for seamless coordination and patient convenience. However, when prior authorization for radiation is delayed, treatment with chemotherapy is also delayed. Combined modality treatment requires a lot of coordination. Radiation is daily and many infusions last several days. We often like to start both treatments on a Monday or Tuesday. Recently, treatment starts have become very unpredictable. It is not a rare circumstance where delays of one to two weeks occur due to prior authorization issues.

This issue remains at the forefront for radiation oncologists and the entire house of medicine, which led to ASTRO signing on to the Consensus Statement on Improving the Prior Authorization Process. The Consensus Statement outlines five areas for improvement for prior authorization programs. One area, the message of Transparency and Communication Regarding Prior Authorization, is extremely resonant in our current environment. Prior authorization requirements and rationale must be easily accessible to providers and patients. Perhaps most important, is the area discussing Continuity of Patient Care that emphasizes that prior authorization should not interrupt appropriate medical services, potentially causing harm and distress to patients.

My experiences are not unique; this issue affects us all. Last fall, more than 500 ASTRO members urged their members of Congress to sign the Roe-Bera Prior Authorization Letter, which called on the Centers for Medicare and Medicaid (CMS) to regulate Medicare Advantage plans’ use of prior authorization and ensure these requirements do not create barriers to care. PRC continues to engage with the American Medical Association and other stakeholders to reform prior authorization practices. ASTRO’s Government Relations team is working with our Hill champions to address prior authorization issues. We frequently provide updates in ASTROgrams and What’s Happening in Washington, so be sure to read those publications.

How has prior authorization impacted the way you practice? Let us know in the comments, or email  healthpolicy1@astro.org.

Posted: April 24, 2019 | 0 comments


Transportation help for patients: Where the rubber meets the road

By Dave Adler, ASTRO Vice President of Advocacy

Radiation oncologists looking to provide their patients with local transportation services to access their clinics should closely examine a new road map for health care providers.

For rural radiation oncology patients, travelling long distances on a daily basis for weeks can often be a significant road block in completing radiation treatment regimens. Time away from work and the costs of travel quickly add up for these patients, many of whom are lower income. As part of the new ASTRO Rural Radiation Oncology Initiative, some members have asked whether providing transportation services to shuttle patients to their daily treatments constitutes a beneficiary inducement under the Anti-Kickback Statute (AKS).

As background, beneficiary inducement rules prevent providers from offering patients remuneration that they know is likely to influence the selection of a provider. While designed to protect patients and the Medicare program from abusive practices, some policymakers and providers, particularly in rural and underserved areas, expressed concern that the rules lacked street smarts and restricted access where there was a low risk of abuse.

On January 6, 2017, the Department of Health and Human Services Office of Inspector General  issued new rules that codified new safe harbors and exceptions to the beneficiary inducement provisions. Thanks to the changes, a local transportation program may provide free transportation to and from health care provider appointments for established patients of a provider. According to Crowell Moring LLP, ASTRO’s outside legal counsel firm, to be protected under the safe harbor, transportation services must follow these rules of the road:

  • Free or discounted transportation services may be provided to patients to travel to and from appointments with health care providers or suppliers.
  • The availability of free or discounted local transportation services cannot be determined in a manner related to the past or anticipated volume or value of federal health care program business to or from an individual or entity.
  • The transportation services made available cannot consist of air, luxury or ambulance transportation.
  • A transportation program or the availability of transportation services cannot be publicly marketed.
    • Marketing includes posting signage in public areas, including waiting rooms or lobbies of provider locations, posting online or otherwise communicating en masse the existence a transportation program or available transportation services.
    • To ensure no public marketing, the availability of free or discounted transportation services should be discussed with a patient only based on a reasonable belief that the individual patient both: (1) is currently a patient of the affiliated provider, and (2) needs free or discounted transportation services to be able to keep his appointments.
  • Transportation services may be made available only to established patients of the health care provider location to which they require transportation. A patient is considered “established” after he or she selects and initiates contact with a provider to schedule an appointment.
  • The entity making arrangements for the transportation must also be the entity bearing the costs of the services. The cost burden cannot be shifted to a federal health care program.
  • Services must be offered to patients only for the purpose of obtaining medically necessary items and services.
  • A slightly less extensive set of requirements apply to a “shuttle service” that runs along a pre-established route.
  • Transportation services can only be available for distances up to 25 miles in urban areas and 50 miles in rural areas.

 

While the rules could put some radiation oncology clinics on easy street to provide transportation services to patients, there is concern that the 50-mile restriction for rural areas will stop traffic. We’re interested in hearing from members on these issues, including:

  • Are these rules right up your alley and allow your practice to provide enhanced transportation services?
  • Is the 50-mile restriction a dead end for reaching patients in rural areas?
  • Have you identified any innovative approaches that are the ticket to ride for providing transportation services to patients in rural areas?

 

Enter your response in the comment section below, we look forward to your feedback.

Before putting the pedal to the metal to offer local transportation, ASTRO members should avoid blind alleys by consulting their practice’s legal counsel to ensure compliance with the new rules and other relevant regulations.

Posted: April 16, 2019 | 0 comments