The Proton Beam Arms Race

The Proton Beam Arms Race

Dear CMS: Stop the proton beam arms race

If Medicare payments for proton beam therapy are what is driving the construction of too many such machines, why doesn’t Medicare change the reimbursement? That’s my simple question for the day.

What prompts it is this story from the Midwest, where University Hospital has entered the proton beam machine arms race with plans to spend $30 million. Here’s the story from MedCity News.

Excerpts:

Few argue that proton therapy is ineffective, though many would like to see it subjected to rigorous testing. The National Cancer Institute (NCI) in 2009 expressed concern that “enthusiasm for this promising therapy may be getting ahead of the research.” NCI experts worry about a lack of published randomized, controlled trials that show proton therapy works better than standard radiation therapy and increases survival, or improves quality of life for patients.

Cost is also a huge concern associated with proton therapy — and one reason so many hospitals are eager to jump into the proton therapy business. Medicare reimburses proton therapy at about twice the rate of standard radiation therapy, which prompts concerns that patients (or their insurers) could pay twice the price for a treatment that may be no more effective than the cheaper alternative.

This one would be paid for by a “a mix of capital, bonds and philanthropy,” according to Cleveland.com. What an obfuscation. No, it will be paid for with money! All of which has an opportunity cost. Dear Ohioans, you can do better with your money than throwing $30 million into this machine.

Open letter to Don Berwick at CMS:

Please make them stop. You can dry up this source of funds and improve health care and help control its escalating cost. Use the tools you have at hand.

We have great respect for former BI-Deaconess CEO Paul Levy. We’re particularly enamored by his insistence on administrative transparency and reimbursements for evidence-based therapies. Commonsense managerial goals like this that can do a lot to improve quality and reign in healthcare costs.

But, in an open letter on his blog, he asked CMS to stop the proton beam arms race. And, as gadget lovers and fans of science fiction, that was a little tough for us to stomach.

We’ve been following the application of proton beams ever since its appearance on Star Trek and were delighted to learn that doctors could use them for cancer therapy, as well. The idea is tumors can be destroyed or shrunk with more localized tissue irradiation than other external beam therapies.

The therapy is enormously expensive, and despite the operation of 29 proton beam centers worldwide and several decades of research, it’s not clear whether this therapy provides better outcomes (though it seems fewer side effects are noted).

Levy’s not arguing that proton beam therapy should stop, only that Medicare should stop reimbursing providers for using it until there is compelling evidence of its efficacy. And while that’s a reasonable argument, we can’t help but worry that limiting payments for this practice will limit its adoption, development and study. And that may leave us vulnerable when the Klingons attack.

Source : http://runningahospital.blogspot.in/2011/05/dear-cms-stop-proton-beam-arms-race.html

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