JM: NAPT continues to engage with CMS and CMMI to ensure payers understand the value of proton therapy. It has been a challenge for payment models, such as the RO model, to adequately recognize the short- and long-term cost savings of advanced radiotherapy techniques. Commercial payers who acknowledge recent clinical research supporting the benefits of proton therapy are including this technology as a covered benefit for certain tumors. Unfortunately, radiation oncology overall has experienced a steady decline in reimbursement over the past decade. But the main driver of cancer care costs is hospitalizations and chemotherapy in the last few months of life, not advances in radiation oncology A study published in JAMA Oncology in 2019 showed that when combined with chemotherapy, proton therapy reduced the incidence of adverse side effects such as hospitalizations. Although proton therapy has higher upfront costs, reducing toxicity of treatments can reduce costly short and long term side effects and allow patients to return to a productive life.. NAPT will continue to advocate for fair and stable reimbursement.
HCB News: What advice do you have for providers who want to refer patients for protons, but aren't sure where to begin? JM: The NAPT website has a map that lists U.S. proton therapy centers and includes contact information. We also have a list of resources to help with lodging and transportation for patients who need to travel to receive care. Our member centers also work directly with patients to reduce barriers and guide patients through the referral, insurance, and treatment process.
EN: For providers who want to refer patients for proton therapy but aren't sure where to start, I first recommend researching where the nearest proton center is located. If you are unsure, you can access the NAPT website which has numerous great resources. For those who have access to a local proton center, I recommend contacting the center for patient referral. Most proton centers have a streamlined, patient friendly intake process. In the scenario where a patient may need to travel out of state, most proton centers will offer a review of the clinical details prior to seeing the patient (and subsequent travel) to ensure proton therapy eligibility. While many providers work with a great local radiation oncology team, sometimes there may be provider and/or patient hesitancy to refer to proton therapy and seeking a second opinion may be considered.