More than 75 ASTRO members pushed for key radiation oncology initiatives to benefit patients, physicians and researchers
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During the American Society for Radiation Oncology’s (ASTRO’s) 11th annual Advocacy Day in Washington, D.C. on May 5-6, 2014, more than 75 ASTRO members met with more than 150 congressional members from their 32 home states. Attendees, including radiation oncologists, nurses, administrators and a record of 24 radiation oncology residents, urged Congress to close the self-referral loophole, to stabilize Medicare physician payments, to provide sustainable funding for radiation oncology-specific cancer research, and to preserve and increase funding for additional residency slots in the nation’s Graduate Medical Education (GME) program.
“It is imperative that our nation’s Medicare infrastructure and resources be judiciously preserved and strengthened. Closing the self-referral loophole, repealing the SGR, and providing increased funding for cancer research and medical residency programs are essential to shoring up our finite resources and investing in the future of cancer care,” noted Colleen A.F. Lawton, MD, FASTRO, chair of ASTRO’s Board of Directors. “We are eager to work with leaders in Washington to ensure that meaningful reforms are achieved so that we can continue to provide high-quality, safe, life-saving radiation therapy to more than one million cancer patients each year.”
ASTRO is concerned that the in-office ancillary services (IOAS) exception loophole in current federal self-referral laws is compromising patient care. The physician self-referral law, the Ethics in Patient Referrals Act, prohibits physicians from referring a patient to a medical facility in which he or she has a financial interest to ensure that medical decisions are made in the best interest of the patient without consideration of any financial gain. The IOAS exception currently allows physicians to refer patients for radiation oncology treatments and certain other services in which they have a financial interest. Numerous independent reports and studies, from the Government Accountability Office (GAO), the Simpson-Bowles Project and a landmark study in The New England Journal of Medicine, have confirmed that abuse of the IOAS exception has led to increased costs to patients and Medicare, as well as inappropriate use of diagnostic and therapeutic services. Often, the patient is not aware that their physician has a financial interest in which treatment they choose. Reps. Jackie Speier (D-Calif.) and Jim McDermott (D-Wash.) introduced the Promoting Integrity in Medicare Act of 2013 (H.R. 2914), which would close the IOAS loophole and limit its use to integrated and truly collaborative multi-specialty group practices.
Recent estimates from the Congressional Budget Office and President Obama predict substantial savings of $3.4 billion and $6.1 billion respectively, by closing the IOAS exception for anatomic pathology, advanced imaging, physical therapy and radiation therapy. These significant savings produced by closing the IOAS loophole should be allocated to offset the costs of repealing and/or permanently fixing the sustainable growth rate (SGR) formula for physician payments.
ASTRO supports efforts to develop a Medicare payment system driven by quality, rather than volume, as in the current fee-for-service structure, in order to stabilize and strengthen the Medicare program. The SGR formula has been patched and re-patched 16 times with short-term “doc fixes” since 2003. With the development of new alternative payment models and permanent repeal of the SGR, patients will benefit from a more stable health care environment that is able to focus on quality of care.
The development and use of new and emerging technologies and treatments are achieved through vital research and clinical trials. Federal funding of radiation oncology-specific research through the National Institutes of Health (NIH) was less than 1 percent of the total NIH budget for Fiscal Years 2010 and 2011, and a little more than 4 percent of the National Cancer Institute’s (NCI’s) budget was devoted to radiation oncology-specific projects. NCI has also experienced a more than $450 million decrease in funding in the FY 2014 NIH budget, which will reduce the allowance of patient enrollment in clinical trials by 30 percent in FY 2014. Decreased patient enrollment in clinical trials will impact the progress of ongoing trials and decrease the number of clinical trials, and ultimately slow the development of new cures. Sustainable and predictable funding for cancer research, with increased allocation for radiation oncology, is essential in our fight against cancer in order to continue the advancement of treatment and the quest for a cure.
The nation’s GME program supports graduated medical students’ progress to become competent practitioners in medicine, including radiation oncology, and provides for the physicians needed to address the nation’s physician workforce needs. The Association of American Medical Colleges projects a shortage of 91,500 physicians by 2020, which will grow to 130,600 by 2025. The federal government contributes approximately $10 billion in Medicare funds to help support GME annually, which provides the majority of funding to the approximately 115,000 physicians currently in the more than 1,000 residency programs. The President’s FY 2015 budget proposes to decrease funding for the GME program by $14.6 billion over 10 years. Reduced funding for GME will significantly impact many hospitals’ and academic programs’ ability to provide GME, thus directly decreasing the number of physicians. Preserving critical GME funding for existing programs and increasing the number of Medicare-supported training positions for medical residents are vital investments in supporting our next generation of physicians who will care for millions of cancer patients nationwide.