Monthly Archives: September 2015

Why is Medicare trying to Destroy Free Standing Practices?

Dr. Hughes is actively involved in working with Ohio politicians to ensure that you have access to the healthcare that you deserve. Here is a letter that Dr. Hughes sent to our Congressman, Senators and local representatives. If you would like to help in this fight for better quality healthcare at a fair price, we recommend that you contact your representatives as well.

In sum and substance, CMS (Medicare) continues to undervalue payment to freestanding radiation oncology centers. I call your attention to a letter from the American College of Radiation Oncology that was sent to Mr. Andrew Slavitt, the acting administrator of CMS.

The most egregious finding is that CMS facility-based payments to freestanding cancer centers have declined 24.2% between 2005 and 2016, while facility-based payments to hospitals have increased 16.7%. The data are found on page 3 of the letter. The differential is enormous-40.9%

I am sure you are familiar with the legal term “Qui Bono?” I understand from my reading of a legal dictionary that the Latin words mean “As a Benefit to Whom?”

So permit me to ask you, who benefits from the proposed further reduction of CMS payments to freestanding oncology centers?

1). Certainly not Medicare patients who will pay more out of pocket for exactly the same services delivered by the exactly same equipment in the hospital verses freestanding centers.

2). Certainly not CMS and ultimately the taxpayers who will pay more for exactly the same services delivered in the hospital versus in freestanding centers.

So why single out freestanding cancer centers for continued dramatic reductions in payments? After all, freestanding radiation oncology centers now represent only a small fraction of CMS payments for radiation oncology services across the country. In fact, in the state of Ohio, only 5 freestanding cancer centers are left. The vast majority have been acquired at bargain basement prices or from bankruptcies over the past several years. So why try to drive us out of business?

Let me propose that it’s the Big Hospitals who benefit most from further reduction in payments to freestanding oncology centers. The proposed CMS reduction will be the death knell for the 5 remaining freestanding oncology centers in Ohio.

With the only competition eliminated, Big Hospitals will be emboldened to charge more for their services, especially from private carriers. CMS will have no alternative. Prices will rise, access will be limited and quality care will decrease.

RECOMMENDATION:   I urge you to call Mr. Slavitt and recommend against further reduction in CMS payment to freestanding radiation oncology centers. I would request that you at least put us on par with the payment to hospitals.

 

Proposed Medicare cuts to radiation therapy are bad medicine By Christopher M. Rose, MD

This blog is being re-posted in it’s entirety as it was seen on http://thehill.com/blogs/congress-blog/healthcare/252582-proposed-medicare-cuts-to-radiation-therapy-are-bad-medicine#.Vfm9FPHAlIE.facebook

September 03, 2015, 05:30 pm

Proposed Medicare cuts to radiation therapy are bad medicine

By Christopher M. Rose, MD

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Cancer is a cruel disease.  It is unpredictable and indiscriminate, and it continues to take nearly 600,000 American lives each year.  Yet despite its unforgiving nature, countless patients continue to show resolve in the face of adversity.  And with each passing day, more and more of our friends, family, and loved ones win the battle against cancer – something once considered impossible.

Advances in technology and vastly improved treatment methods have allowed us to better identify, target, and treat cancer.  Accordingly, survival rates have improved for many types of cancer.

As a practicing radiation oncologist and the chief technology officer of Vantage Oncology, a member of the Radiation Therapy Alliance – a coalition of 296 freestanding cancer care facilities in 35 states caring for more than 100,000 patients annually – I witness daily improvements in care that positively impact patients and their families. And with a continued effort towards innovation, there is truly hope for a better, healthier future where many cancers will be abolished and others managed as a chronic disease, much like heart disease or diabetes.

We’ve truly reached a tipping point in the management of cancer.

For this reason, it is especially alarming that the Centers for Medicare & Medicaid Services (CMS) is threatening the vitality of critical cancer care services in its proposed Physician Fee Schedule (PFS) regulation for 2016.  The proposed rule would cut payments to freestanding radiation therapy centers by six percent in 2016.  This is on top of cuts to freestanding centers that have totaled almost 20 percent over the last decade.

These proposed changes could have devastating effects on the delivery of cancer care, particularly care provided in freestanding radiation oncology centers nationwide. By cutting payments to cancer care providers, the government is putting at risk an important safety net for millions of Americans in need of radiation therapy – and, in turn, jeopardizing the health and wellbeing of our nation’s most vulnerable patients.

Simply put, the proposed cuts are bad medicine for America’s cancer care providers and their patients.  Nearly 65 percent of all cancer patients are treated with radiation therapy during their course of care.  And nearly 40 percent of all radiation therapy is currently delivered in a community-based, freestanding setting.  As a result of recent cuts in the 2016 PFS proposed rule freestanding centers will now be paid at 80 percent of overall hospital rates. This is indefensible even though the direct costs for the services, the quality of care, and the outcomes of the care are identical.  It will be impossible for many freestanding facilities to survive.

Treatment for specific cancers – prostate and breast cancer – would experience the most damaging cuts.  If the proposed PFS changes were adopted, the payments for a course of care for prostate and breast cancer will be reduced by 25 percent and 19 percent, respectively.  Furthermore, this same care will be reimbursed 36 percent less and 32 percent less, respectively, in the freestanding setting than care delivered in the hospital setting.

This prospect is particularly alarming for minority populations, which experience higher rates of both prostate and breast cancers, according to data from the American Cancer Society.  In fact, 37 percent of all new prostate cancer diagnoses in the U.S. are among African American men and 33 percent of all new breast cancer cases are among African American women.

If more radiation therapy centers are forced to close due to Medicare cuts, all cancer patients will suffer, however individuals from minority populations will likely feel an even greater impact. For years, freestanding radiation therapy facilities have played a fundamental role in bolstering access to high quality cancer care among traditionally underserved minority populations and, in turn, elevating health outcomes.  Peer reviewed research shows that limited access to radiation oncology in less populated areas is associated with increased rates of prostate cancer mortality.  Peer reviewed data also show longer travel times to an oncologist are associated with lower rates of breast conserving therapies.  By cutting reimbursement rates to freestanding oncology centers, the government is threatening critical cancer care services.

We can and must do better.  We have made important strides in cancer care.  There are rational ways to normalize reimbursement across the continuum of care delivery environments. Let’s make sure we protect these vital services in the freestanding setting and protect patient access and choice for those battling cancer.

To that end, I urge Congress to ask their colleagues at CMS to reconsider these potentially devastating cuts to freestanding radiation oncology.  Let’s not turn back the clock on cancer care. 

Rose, FASTRO, is the chief technology officer of Vantage Oncology, Inc. 

Elderly Lung Cancer Patients Fear the Treatment More Than the Disease

Cyber Knife is the answer for early stage lung cancer.

Cyber Knife is the answer for early stage lung cancer.

So many of my elderly patients are now asking whether it’s worth it or not to treat early-stage lung cancer.  “I have to die of something!” is a typical response to receiving a lung cancer diagnosis.

But Dr. Walter Curran and colleagues from Emory University School of Medicine may now have a good answer to that important question.  From 2003-2006, the National Cancer Data Base was analyzed for patients 70 years or older with early stage lung cancer who chose either a watch and wait approach or stereotactic radiosurgery, like that delivered by Cyber Knife.  Their findings were reported in the August 2015 Journal of Cancer. The results were striking.  Senior patients with early stage lung cancer treated with stereotactic radiosurgery had better survival than those patients who chose a watch and wait approach.  Importantly, those patients were treated with stereotactic radiosurgery were no sicker initially than those who chose a watch and wait approach.  And they fared much better afterwards.

Stereotactic Radiosurgery, Like that Delivered by Cyber Knife, May be the Solution to Those Fears 

Stereotactic radiosurgery, like that delivered by Cyber Knife, has produced the same lung cancer control rates as surgery for early stage lung cancer patients, but with far fewer side effects.  No incision.  No pain.  And no hospitalization.  Cyber Knife is done on an outpatient basis.  It’s now considered the standard of care for early stage lung cancer patients who are “medically inoperable” or too sick for surgery.

Recent results indicate that Cyber Knife stereotactic radiosurgery may be just as good as open surgery for medically operable patients, or those patients who are healthy enough for open surgery like lobectomy or video-assisted lobectomy.  In a study in the June 2015 issue of the medical journal Lancet Oncology, Dr. Chang and coworkers reported that early-stage lung cancer patients treated with stereotactic radiosurgery had a 95% survival at 3 years versus only 79% for patients with surgery.  And the complications with open are far more severe.  My conclusion is that Cyber Knife radiosurgery may be just as good as open surgery even for young patients who are fit as a fiddle.

So What’s  a Senior with Early Stage Lung Cancer To Do?

Dr. Jonathan Beitler  of Johns Hopkins, commenting on this study, stated “I have to say that it seems to be the surgical community has resisted a large-scale randomized trial and from their point of view, who could blame them?  On the other hand, are they looking out for the patient’s or for themselves?”  That’s a sobering thought.  While I’ll never comment on another person’s motives, I know that it can take a while before doctors change their practice habits.  After all, it took over 50 years for surgeons to learn that a radical mastectomy just simply didn’t work.  More is not always better.  I do think it’s a good idea, may be even mandatory, for all early-stage lung cancer patients, young or old, to see a radiation oncologist experienced in Cyber Knife before undergoing the cold, hard steel sharp edge of the scalpel.  It just may be in the patient’s best interest.  Each and every week when I see early-stage lung cancer patients in consultation, I have to dispel a lot of myths about Cyber Knife.  In this day of data driven decision making, it’s important to have the facts from a number of sources.
So if you have any questions, please feel free to call me, Dr. Ed Hughes, at 855-DAYTON1.

September is Prostate Cancer Awareness Month

Learn the symptoms of prostate cancer and what types of treatments are available from Dr. Ed Hughes. Share this with all the men in your life.

 

Lung Cancer Screening with Low Dose CT scans: Do The Pro’s Outweigh the Con’s?

A simple and painless CT scan, could save your life.

The Heart of the Problem

Death from lung cancer in the USA is staggering-160,000 Americans will die of lung cancer each and every year.  Over 225,000 American men and women are diagnosed with lung cancer, but the vast majority, nearly 85%, are diagnosed with locally advanced lung cancer.  And only 17% of all lung cancer patients will survive.  That’s why, for many Americans, lung cancer represents a death sentence.  Less than 15% of Americans are diagnosed with early stage lung cancer, usually as the result of a CT scan of the chest done for other reasons.

American medicine has made tremendous breakthroughs in the treatment of lung cancer: stereotactic radiosurgery, like that delivered by Cyber Knife, and immunotherapy, like Nivolumab, are leading the way in the treatment of early stage and locally advanced lung cancer, respectively.  But the problem is that only 15% of Americans are diagnosed at an early stage, when their lung cancer is highly curable.  In fact, early stage lung cancer has an 80-90% cure rate.

Is Screening with Low Dose CT scans the Answer?

A major study, called the National Lung Screening Trial or NLST for short, enlisted 53,454 men and women smokers and screened them every year for 3 years with low dose CT scans.  The NLST results were outstanding-a 20% reduction in death from lung cancer as a result of the use of low dose CT scans.  These breakthrough results translate into saving about 20,000-30,000 American smokers each and every year from the ravages of lung cancer.

 But screening alone is only part of the answer.  One study showed 14% of smokers who underwent screening quit, twice the rate of the smoking population in general.  Yet another recent study showed quite the opposite-many smokers with negative low-dose CT scans continued to smoke.  It was as if a negative low dose screening CT scan gave them a new lease on their smoking lives.  So enrolling smokers in a program to get them to quit smoking may also be the key.

So What are the Pitfalls of Low-Dose CT scanning?

The American NLST study was huge-enrolling over 53,000 Americans.  And the NLST was the so-called gold standard- a prospective, randomized trial.  The NLST was twice the size of the European NELSON trial that had 15,522 participants.  Still, a major point of concern in the American NLST study is that the results have not been reproduced.  At least 2 similar studies in Europe, albeit much smaller, failed to show any effect on lung cancer survival by low dose CT scan screening.

The second cause for concern is that a number of smokers may have a so-called “false positive.”  That is to say, a worrisome spot found on low-dose CT scan that is benign-not cancer at all.  A number of maneuvers may help reduce the anxiety and expense of a so-called “false positive.”  For example, if the cut off in size of a worrisome spot was increased from 4 mm to 6 mm, the “false positive rate” in the NLST study would have been reduced by over 50%.

And other imaging studies, like PET scans, can help sort out whether a biopsy or bronchoscopy or even an open surgery is needed.

So What Is a Smoker To Do?

The upfront, out-of-pocket self pay cost for low-dose CT scan for lung cancer screening is $89-$99 in Dayton Ohio-the cost of the couple cartons of cigarettes.  In addition, a number of private insurance companies have agreed to start paying for low-dose CT scan screening for smokers. Medicare is sorting out the details for reimbursement right now. CMS has agreed that this should be a routine annual screening for those who qualify.

The unspoken risk is also that of radiation exposure.  Yet the radiation exposure risk of a low-dose CT scan is very low-about 1.5 mSv.  So what does that number mean?  Whether you know it or not, the yearly exposure of all Americans to “background” ionizing radiation, mostly from cosmic rays, is 2.4 mSv.  So not such a big deal for an occasional screening low-dose CT scan that can save your life.

So when all is said and done, I think screening with low dose CT scans is a good thing for smokers. If you fall under this criteria, you need to have a conversation with your physician about having a screening. You need to be a part of the decision making process that may include counseling for smoking cessation if you are a current smoker.

These are the recommendations for who should be screened.

Screening men and women age 55-77:

Asymptomatic (no signs or symptoms of lung cancer);

               • Tobacco smoking history of at least 30 pack-years (one pack-year =            smoking one pack per day for one year; 1 pack = 20 cigarettes);

Current smoker or one who has quit smoking within the last 15 years.

If you have any questions, please feel free to call me, Dr. Hughes, at 855-Dayton1.

Lung Cancer Screening with Low Dose CT scans: Do The Pro’s Outweigh the Con’s?”

A simple and painless CT scan, could save your life.

The Heart of the Problem

Death from lung cancer in the USA is staggering-160,000 Americans will die of lung cancer each and every year.  Over 225,000 American men and women are diagnosed with lung cancer, but the vast majority, nearly 85%, are diagnosed with locally advanced lung cancer.  And only 17% of all lung cancer patients will survive.  That’s why, for many Americans, lung cancer represents a death sentence.  Less than 15% of Americans are diagnosed with early stage lung cancer, usually as the result of a CT scan of the chest done for other reasons.

American medicine has made tremendous breakthroughs in the treatment of lung cancer: stereotactic radiosurgery, like that delivered by Cyber Knife, and immunotherapy, like Nivolumab, are leading the way in the treatment of early stage and locally advanced lung cancer, respectively.  But the problem is that only 15% of Americans are diagnosed at an early stage, when their lung cancer is highly curable.  In fact, early stage lung cancer has an 80-90% cure rate.

Is Screening with Low Dose CT scans the Answer?

A major study, called the National Lung Screening Trial or NLST for short, enlisted 53,454 men and women smokers and screened them every year for 3 years with low dose CT scans.  The NLST results were outstanding-a 20% reduction in death from lung cancer as a result of the use of low dose CT scans.  These breakthrough results translate into saving about 20,000-30,000 American smokers each and every year from the ravages of lung cancer.

 But screening alone is only part of the answer.  One study showed 14% of smokers who underwent screening quit, twice the rate of the smoking population in general.  Yet another recent study showed quite the opposite-many smokers with negative low-dose CT scans continued to smoke.  It was as if a negative low dose screening CT scan gave them a new lease on their smoking lives.  So enrolling smokers in a program to get them to quit smoking may also be the key.

So What are the Pitfalls of Low-Dose CT scanning?

The American NLST study was huge-enrolling over 53,000 Americans.  And the NLST was the so-called gold standard- a prospective, randomized trial.  The NLST was twice the size of the European NELSON trial that had 15,522 participants.  Still, a major point of concern in the American NLST study is that the results have not been reproduced.  At least 2 similar studies in Europe, albeit much smaller, failed to show any effect on lung cancer survival by low dose CT scan screening.

The second cause for concern is that a number of smokers may have a so-called “false positive.”  That is to say, a worrisome spot found on low-dose CT scan that is benign-not cancer at all.  A number of maneuvers may help reduce the anxiety and expense of a so-called “false positive.”  For example, if the cut off in size of a worrisome spot was increased from 4 mm to 6 mm, the “false positive rate” in the NLST study would have been reduced by over 50%.

And other imaging studies, like PET scans, can help sort out whether a biopsy or bronchoscopy or even an open surgery is needed.

So What Is a Smoker To Do?

The upfront, out-of-pocket self pay cost for low-dose CT scan for lung cancer screening is $89-$99 in Dayton Ohio-the cost of the couple cartons of cigarettes.  In addition, a number of private insurance companies have agreed to start paying for low-dose CT scan screening for smokers. Medicare is sorting out the details for reimbursement right now. CMS has agreed that this should be a routine annual screening for those who qualify.

The unspoken risk is also that of radiation exposure.  Yet the radiation exposure risk of a low-dose CT scan is very low-about 1.5 mSv.  So what does that number mean?  Whether you know it or not, the yearly exposure of all Americans to “background” ionizing radiation, mostly from cosmic rays, is 2.4 mSv.  So not such a big deal for an occasional screening low-dose CT scan that can save your life.

So when all is said and done, I think screening with low dose CT scans is a good thing for smokers. If you fall under this criteria, you need to have a conversation with your physician about having a screening. You need to be a part of the decision making process that may include counseling for smoking cessation if you are a current smoker.

These are the recommendations for who should be screened.

Screening men and women age 55-77:

Asymptomatic (no signs or symptoms of lung cancer);

               • Tobacco smoking history of at least 30 pack-years (one pack-year =            smoking one pack per day for one year; 1 pack = 20 cigarettes);

Current smoker or one who has quit smoking within the last 15 years.

If you have any questions, please feel free to call me, Dr. Hughes, at 855-Dayton1.