by Loren Bonner
, DOTmed News Online Editor
Medicare reimbursement rates for proton therapy included in the final Hospital Outpatient Prospective Payment System (HOPPS) rule for 2013 reflect significant reductions from 2012.
Specifically, the code for ambulatory surgical center payment systems (APC) in the HOPPS rule that applies to proton treatment "complex" procedures — harder to treat procedures — decreases the mean payment for proton therapy from $1,549 in 2012 down to $682 for 2013.
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According to the Advisory Board Company, a global research and consulting firm, this translates into a 32 percent decrease in revenues from an average of $35,917 per patient in 2012 to a projected average of $24,565 per patient for 2013.
All other radiation therapy techniques, like stereotactic body radiosurgery (SBRT) and intensity modulated radiation therapy (IMRT), will be reimbursed only slightly lower than in 2012, according to the new rule for 2013.
The Centers for Medicare and Medicaid Services released the proposed rule this summer. During the comment period, stakeholders argued that the decrease in the cost of proton therapy was due to flawed and incorrect data by one hospital during 2010 and 2011. The University of Pennsylvania's proton therapy center owned up to the mistake and tried to get CMS to fix the data. However, the agency decided not to take that into account for 2013, and stuck by what it originally proposed.
On Nov. 7, the American College of Radiology submitted comments to CMS about the final rule, urging them not to go forward with the proposed cuts for 2013, "due to the concern that some of the data used in CMS' analysis was not representative of proton beam therapy's true costs," stated the letter.
Leonard Arzt, executive director of the National Association for Proton Therapy, said any reimbursement reductions either by Medicare or private insurers could have serious future implications for cancer patients seeking and demanding proton therapy.
CMS published the final rule on Nov. 15.