If all of Medicare had to take a 2% hit so that more was available for primary care, it would be very hard for me to argue with that,” said Albert Blumberg, MD, chair of the ACR Commission on Radiation Oncology. “That’s a policy decision the government has a right to make. But to make an arbitrary decision based on something that’s not scientific, that’s not data-driven, is so bizarre and so far out of the realm of anything that’s been previously done, it just boggles my mind.”

Albert Blumberg, MD, Chair, ACR Commission on Radiation Oncology.

Blumberg was referring to the proposed 2013 Medicare Physician Fee Schedule. It includes cuts across the board, but radiation oncology takes an especially hard hit—a 15% cut for radiation oncology overall, a 19% cut for freestanding centers, a 40% cut for intensity modulated radiation therapy (IMRT), a 28% cut for stereotactic body radiation therapy (SBRT). Although the cuts are significant, the numbers themselves are not the crux of Blumberg’s objections. He disagrees with the method CMS used to arrive at those numbers.

“It’s frustrating that [CMS] would propose this based on a completely different methodology than they’re supposed to follow,” he said. “They are supposed to be looking at many items, but they only took one item. They used patient education material, which is written in a simplistic fashion to give patients an overall gestalt, but is not meant to be a scientific account of what goes into it, and it certainly doesn’t go into detail about what goes on behind the scenes.”

For example, Blumberg explained that a radiation oncology practice might have a pamphlet that it distributes to patients that states a procedure will last 30 minutes. Practices intend patients to use the information for their scheduling purposes. It does not necessarily reflect the amount of time needed to prepare, perform, and process the procedure.

“Radiation oncology’s use of IMRT and SBRT is certainly at a higher level of utilization than anyone would have predicted when they were first introduced for coverage within the Medicare program,” Blumberg said. “They are trying to rein in that growth inappropriately, in my opinion.”

With cuts as large as CMS proposed, all centers would be affected. Blumberg said practices that aren’t a part of a large hospital system, where other revenue sources might help offset drops in radiation oncology, would be more exposed to the financial hit. If the proposed cuts are approved, Blumberg said that changes would be unavoidable. “It will affect access, affect the ability of centers to employ critical personnel, they may cut hours, close centers, consolidate centers,” he said. “Some doctors will retire early, some people will be forced to leave smaller communities for larger ones. If I was a young man or woman entering the field, I would be concerned regarding my future.”

Because the proposed cuts are not yet official, Blumberg said he does have some hope that the cuts will be reanalyzed. “I think there’s always room for change,” he said. “There’s a letter circulating Congress asking CMS to think about the disadvantage it’s putting on patients in rural America.”

Blumberg expects a November ruling on the proposal. Until then, he and many others in the field will be watching closely.