By Najeeb Mohideen, MD, FASTRO
It’s been two years since I assumed the mantle of Senior Editor of ASTROnews
. In that time, we’ve welcomed a new managing editor and two new editorial board members, brought the issue back into print from a year of being online-only, changed up the back departments and tackled a litany of topics of interest to our readers: from emerging immunotherapy research
to the diversity of the radiation oncology workforce
Now it’s time for us to assess our progress; to take stock of where the magazine is now and where it should be headed. Like we do when we’re treating patients in the clinic, we have to look at our results to see if we’re moving in the right direction: Is the plan working? Have we gone off course? Could it be refined?
Just as we strive for the optimal treatment plan for our patients, the ASTROnews
editorial board and I strive to make your member magazine as relevant and useful as possible. We are collecting information to see what’s working in ASTROnews
and what could use some improvement.
We want to know if you read ASTROnews
—and how you prefer to read it: online, in print, a mixture of both? Would you read online-only content on our website in between issues? Do you find the issue themes and related stories applicable to your practice? What themes should we address in future issues?
Please take a moment—it takes less than 10 minutes—to fill out the brief survey
with your thoughts about ASTROnews
. Let me thank you in advance for taking the time to share your feedback with us so that we can, in turn, focus in on the topics of greatest interest to our readers.
By Lisa A. Kachnic, MD, FASTRO, Chair, Annual Meeting Scientific Committee
A strong selection of late-breaking abstracts was submitted for this year’s ASTRO Annual Meeting. A total of 61 abstracts were received within the late-breaking abstracts window between July 19 and August 1, and 10 of them have been selected for oral presentation.
An important, practice-changing study, NRG-RTOG 1016: A Phase III Trial Comparing Radiation/Cetuximab to Radiation/Cisplatin in HPV-related Cancer of the Oropharynx, has been added to the Plenary Session. An interim analysis of data from a randomized clinical trial of patients with human papillomavirus (HPV)-positive oropharyngeal cancer found that treatment with radiation therapy and cetuximab is associated with worse overall and progression-free survival compared to the current standard treatment with radiation and cisplatin. Full study details will be presented on Monday, October 22 in San Antonio. A second late-breaking abstract has also been added to the Plenary Session, Short Term Androgen Deprivation Therapy Without or With Pelvic Lymph Node Treatment Added to Prostate Bed Only Salvage Radiotherapy: The NRG Oncology/RTOG 0534 SPPORT Trial.
Three late-breaking abstracts have been chosen for the Clinical Trials Session. These include:
- A Randomized Trial Evaluating Radiation following Surgical Excision for “Good Risk” DCIS: 12-year Report from NRG/RTOG 9804.
- FAST Phase III RCT of Radiotherapy Hypofractionation for Treatment of Early Breast Cancer: 10-year Results.
- Local Consolidative Therapy Improves Overall Survival Compared to Maintenance Therapy/Observation in Oligometastatic Non-Small Cell Lung cancer: Final Results of a Multicenter, Randomized Controlled Phase II Trial.
The Late-breaking Abstracts Special Session will feature five more late-breaking abstracts:
- Preservation of Neurocognitive Function with Conformal Avoidance of the Hippocampus During Whole-brain Radiotherapy for Brain Metastases: Preliminary Results of Phase III Trial NRG Oncology CC001.
- Overall survival with Durvalumab versus Placebo after Chemoradiotherapy in Stage III NSCLC: Updated Results from PACIFIC.
- Plasma Circulating Tumor HPV DNA for the Surveillance of Cancer Recurrence in HPF-associated Oropharyngeal Cancer.
- An International Randomized Phase III Trial Evaluating Efficacy and Safety in First-in-Class NBTXR3 Hafnium Oxide Nanoparticles Activated by Preoperative Radiotherapy in Locally-advanced Soft Tissue Sarcoma.
- Preoperative Chemoradiotherapy Potentially Improves Outcome for (Borderline) Resectable Pancreatic Cancer: Preliminary Results of the Dutch Randomized Phase III Preopanc Trial.
Abstracts submitted as late-breaking abstracts must meet specific criteria. Research is limited to highly significant and timely findings in clinical oncology, radiobiology or medical physics that were not available prior to the February 14 abstract submission deadline. Only abstracts deemed to be of high scientific priority are considered for presentation in the Plenary, Clinical Trials or late-breaking abstract sessions, and so standards for accepting late-breaking abstracts for presentation are much higher than those for abstracts accepted for the general scientific sessions.
A special panel of peer reviewers are responsible for selecting abstracts to be presented. All abstracts are scored, and then the Annual Meeting Steering Committee, comprised of the Chair and Vice-chair of the Annual Meeting Scientific and Education Committees, along with the current ASTRO President, President-elect, Education Council Representative, Best of ASTRO Chair and two statisticians discuss which abstracts fit best in these high-level sessions.
View all the scientific and education sessions to be presented at the 60th ASTRO Annual Meeting, taking place October 21-24, 2018, at the Henry B. Gonzalez Convention Center in San Antonio on the Conference Planner. Register for the meeting by September 13 for advance rates.
By Randi Kudner, ASTRO Senior Quality Improvement Manager
Radiation oncologists and other physicians are struggling to maximize return on investment under the new Merit-based Incentive Program Payment System (MIPS), compounding questions about the new program’s burden and value.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established the Quality Payment Program (QPP) to transition Medicare payment away from fee-for-service to pay-for-performance. Participation in the QPP is through one of two pathways. The Advanced Alternative Payment Model (APM)
is one option; however, only radiation oncologists in a multidisciplinary practice involved in the Oncology Care Model currently have this option. A radiation oncology APM
is currently in development.
The Merit-based Incentive Payment System (MIPS)
is the other option, and it is how most radiation oncologists currently report. MIPS combines and replaces Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VM) and Medicare EHR Incentive (Meaningful Use) programs into one comprehensive program.
The Center for Medicare and Medicaid Services (CMS) recently released feedback data for the 2017 MIPS performance year
. Included in the feedback report is the:
- 2017 final score
- 2019 MIPS payment adjustment
- Final performance category scores and weights
As we work to influence the 2019 QPP proposed rule
, we are also interested in gathering performance data from our members so that we may advocate effectively on theirn behalf. What was the participation rate? What were the scores? How did our members perform?
ASTRO requested feedback data from some groups and has some initial data, but we need more responses to advocate for program improvements. The 2017 program included up to a positive or negative 4 percent payment adjustment for 2019, and many ASTRO members that were initially polled scored a perfect 100. However, when all calculations were averaged, this only equates to a 2.02 percent positive payment adjustment in 2019.
There was little surprise that the positive payment adjustments were lower than the 4 percent ceiling, considering the budget neutral mandate combined with the "Pick Your Pace" option introduced to ease practices into the new program. Yet the fact that the positive adjustment was so low—about half of the maximum—means that some program rules should be reviewed. Realistically, if the program is to succeed, there should be a meaningful financial benefit, alongside the potential quality improvement impact, that offsets the significant cost of participation.
Clinicians and groups can access their 2017 MIPS performance feedback on the QPP website
using an Enterprise Identity Management (EIDM) account. The CMS Guide to Obtaining an EIDM Account
provides instructions on how to create one. If an error was made in the calculation of your 2019 MIPS payment adjustment, you should request a targeted review
from CMS via your EIDM account on the QPP website. Targeted reviews can be submitted until October 1, 2018
. Circumstances warranting such a request include:
- Errors or data quality issues on submitted measures and activities;
- Physician eligibility questions that could, for instance, be related to CMS’s low-volume threshold and that would preclude a payment adjustment;
- An erroneous exclusion from the alternative payment model participation list; or
- Failure to be automatically reweighted due to eligibility provided by CMS’s 2017 extreme and uncontrollable circumstances policy.
Understanding participation, performance and the cost/benefit ratio will inform ASTRO’s recommendations to CMS on future iterations of the program. Please fill out this short survey
to help ASTRO provide suggestions to CMS about how to refine this program moving forward.