This week, U.S. Sen. Marco Rubio, R-Fla., led a bipartisan group of Florida congressional members in writing a letter to Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure urging the agency to exclude low-volume modalities such as proton beam therapy (PBT) from the Radiation Oncology (RO) Model, which is set to begin January 2022 and threatens to cut up to 50 percent in Medicare reimbursements to providers of this high-quality radiation treatment.
Florida-based PBT centers are some of the most advanced in the nation, treating more than 14,000 cancer patients including thousands of pediatric patients to date.
Joining Rubio were U.S. Reps. Gus Bilirakis, R-Fla., Kat Cammack, R-Fla., Byron Donalds, R-Fla., Neal Dunn, R-Fla., Scott Franklin, R-Fla., Al Lawson, D-Fla., Bill Posey, R-Fla., John Rutherford, R-Fla., Greg Steube, R-Fla., and Debbie Wasserman Schultz, D-Fla.
The letter is below.
Dear Administrator Brooks-LaSure:
We write with regard to the Centers for Medicare and Medicaid Services (CMS) proposed Radiation Oncology Model (RO Model) that threatens to cut funding to radiation therapy services that thousands of Floridians rely on to fight cancer. While we appreciate CMS’ efforts to develop an Alternative Payment Model (APM) with the goal of improving cancer care and reducing provider burden, we are concerned that the proposed rule will disproportionately impact innovative cancer therapies, especially Proton Beam Therapy (PBT). Under the RO Model, PBT faces a possible base payment reduction of up to 50 percent compared to other modalities that will see a significantly less reduction.
To date, more than 14,000 cancer patients have benefited from PBT provided at Florida-based centers. It is a more effective, precise, and safer alternative to conventional radiation therapies widely available today. While traditional radiation therapies often harm healthy tissues and organs, PBT limits radiation exposure, thus reducing side effects, and lowering the risk of secondary cancers. Florida’s pediatrics population particularly benefits from PBT as it reduces the risk of developmental, hormonal, muscular, and skeletal deficiencies, including hearing loss. Florida is proud to call the nation’s leading PBT center home, which opened in 2006 and treats patients of all ages, including more than 2,000 children. Furthermore, PBT centers across the state are effectively treating patients who are diagnosed with localized tumors such as brain, breast, head and neck, eye, gastrointestinal, lung, prostate, esophageal, and other cancers. While this RO Model would only impact Medicare beneficiaries, the reimbursement cuts threaten to disrupt care for all PBT patients as these centers treat a significant amount of Medicare patients. The cut to Medicare for cancer modalities continues to negatively impact the most vulnerable in our country, creating further health inequities.
Last year, Congress recognized the importance of protecting innovative RO modalities by delaying the implementation of the RO Model until January 1, 2022. With this deadline fast approaching, we urge CMS to exclude low-volume modalities such as PBT from the RO Model as it did for brachytherapy in the latest final rule. We note that CMS reviewed hospital outpatient episodes of care, of which PBT only made up less than one percent.
At a time when our healthcare providers are still recovering from the COVID-19 pandemic, including PBT in the RO Model will only exacerbate access to quality care, creating additional healthcare inequities for our most vulnerable, and reducing the quality of life for thousands of Floridians. We appreciate your attention to this important matter and look forward to your response.