The National Institutes of Health (NIH) and its National Cancer Institute (NCI) are a central foundation for national cancer research activities. For over 30 years, NCI-funded research has played a role in every major cancer prevention, detection and treatment advance.
Unless the research is sustained Americans could miss out on groundbreaking science. To provide sustainable and predictable funding for the NIH and NCI, ASTRO requests that NIH receive $32.7 billion in fiscal year 2013, providing NCI with $5.36 billion. ASTRO is also requesting NIH and NCI to set aside funding for radiation therapy specific projects. The best way to support this research is through the redesigned, streamlined cancer cooperative groups, known as the National Clinical Trials Network (NCTN). However, the groups' proposed funding level of $178 million per year will lead to a 20 percent decrease in patient accrual in clinical trials. To ensure immediate and long term success of the new clinical trials network, ASTRO is asking Congress to direct NCI to provide $250 million to the NCTN.
Economic benefits to communities
More than 80 percent of the NIH budget is divided up into 50,000 extramural grants at over 3,000 universities and medical schools and other research institutions in every state. In 2010:
- Each dollar of NIH’s $26.6 billion investment generated more than twice as much ($68 billion) in new state business activity in the form of increased output of goods and services.
- NIH grants and contracts created more than 487,000 jobs that generated wages in excess of $18 billion.
ASTRO is very concerned about new business arrangements that have led to a skewed system of cancer treatment referral decisions driven by profits instead of what is best for the patient.
The physician self-referral or “Stark” law was enacted to assure that clinical decisions related to patient treatment are undertaken devoid of financial considerations, thus assuring patients’ access to high-quality services while at the same time discouraging overutilization. The in-office ancillary services (IOAS) exception to the Stark law was intended to apply to treatments and services, like X-rays, that required a quick turnaround to facilitate medical decision making. Radiation therapy services are long-term treatments for cancer and should not be part of this exception.
This exception has led to the creation of business arrangements that could compromise the quality of care and limit treatment options for patients. Patients are usually unaware of the financial incentives involved in these arrangements, and emerging data suggests that patients may not be informed of all of their treatment options. Several publications, including The Wall Street Journal and The Washington Post have published investigations of self-referral abuses in radiation oncology.
ASTRO is committed to closing the self-referral loophole for radiation oncology services to protect patient choice of treatments and preserve the integrity of the Medicare program.
Self-referral toolkit for state-level advocacy.
Congress must permanently fix the Medicare physician payment formula, known as the sustainable growth rate (SGR), to provide stability for radiation oncologists and all physicians who treat Medicare patients.
New technology and improved techniques allow radiation therapy centers to continually improve how to target radiation to kill tumors while protecting healthy tissue. It is imperative that the continued achievements of radiation therapy that improve patient care not be stymied by across-the-board or arbitrary cuts. We urge Congress to provide stability for Medicare providers and patients by immediately enacting a permanent solution.
As it considers how to address the looming Medicare physician payment cuts, ASTRO urges Congress to avoid arbitrary cuts that would limit cancer patients’ access to life-saving treatments. Instead, ASTRO encourages Congress to explore a more targeted approach to cut waste and abuse by closing the self-referral loophole in radiation oncology.
In our ongoing efforts to improve safety, ASTRO has enhanced its patient safety and quality projects and developed an action plan called Target Safely. Below are some of the activities that ASTRO has initiated:
- ASTRO supports minimum education and credentialing standards for radiation therapy personnel through immediate passage of the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging in Radiation Therapy (CARE) Act. In some states, basic training standards are voluntary, allowing individuals to perform radiation oncology procedures without any formal education. Without a minimum level of standards, patients could be at risk.
- ASTRO supports mandating radiation oncology facility accreditation administered through ASTRO and the American College of Radiology (ACR). All hospital and community based centers should participate in this robust program that assesses the qualifications of personnel, policies and procedures, equipment specifications, quality assurance activities, patient safety and ultimately the quality of patient care.
- ASTRO is continuing its dialogue with the Nuclear Regulatory Commission to ensure that patients receive safe, effective radiation therapy treatments.
- ASTRO is leading the creation of a national medical error reporting system and a patient safety database for radiation oncology. This confidential and protected reporting system would not only detect sporadic problems but will also help identify national error trends while allowing for rapid action to correct errors.
- ASTRO has compiled a list of questions for patients to ask their doctors about the safety of their treatment and their treatment team.
All available evidence indicates that radiation oncology errors are very rare. However, one error is too many. We look forward to continuing to create public policy ensuring the highest level of safety for our patients.