Our Emperors Have No Clothes (Breast IMRT)

[TheWallnerus]

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In 2015, the Red Journal publishes an article stating that this 2008 study...

"A multicenter randomized trial of breast intensity-modulated radiation therapy to reduce acute radiation dermatitis,":​

Breast IMRT significantly reduced the occurrence of moist desquamation compared with a standard wedged technique. Moist desquamation was correlated with increased pain and reduction in the quality of life.​

... (despite what you just read) showed "lack of substantial benefits with IMRT" and "... patients who have a more homogeneous dose of RT have fewer side effects and more improved long-term cosmesis than those who do not receive any form of modulated RT dose... However, these homogeneous doses of RT can be delivered by 3D RT technique and do not necessarily require standard IMRT as practiced in the United States... It is this distinction, that improved outcomes do not necessarily require the costliest treatment, that is at the basis for the ASTRO 2013 Choosing Wisely recommendation."


As recently as 2022, ASTRO continued annually publishing its "Choosing Wisely"...

At that time (2022) IMRT paid ~$375/fraction (pays about $340/fraction now) per CMS rates (varies). A standard (ie 3DCRT) fraction reimbursed about $150 in 2022 and $150 now.

And then this happened:

Please note, you can (not easily) find any Internet trace of "Choosing Wisely" anymore.

Come 2026, CMS is proposing to classify any IMRT treatment under either CPT code 77407 or 77412. ASTRO says that any breast irradiation (3DCRT or IMRT, left or right sided), will be done by radiation oncologists under CPTs 77407 or 77412.

The proposal also calls for a payment rate of ~$300 for 77407 and ~$600 for 77412. HOWEVER, ASTRO is asking CMS to pay ~$600 for code 77407 also... 77407 is any standard 3DCRT or IMRT.

Therefore, ASTRO:

1) In the pre-2022 timeframe said:
a. Choose wisely... don't bill IMRT for whole breast irradiation.
b. Instead of billing ~$375/fraction for whole breast irradiation, bill $150/fraction.

2) In the 2022-25 timeframe said "forget what we said in the pre-2022 timeframe."

3) And now says, come 2026, bill ~$600/fraction for non-IMRT breast RT (or practically any curative irradiation for that matter)... and use IMRT whenever you want, because IMRT reimbursement doesn't matter anymore.

 

[Palex80]

Dug it out of my ASTRO 2013 slides.

 

[RickyScott]

Astro would like you to think that toxic health care economics is about over utilization not the extortionistic prices at the board members own instituitions. The rest of the world is almost entirely imrt even for Mets. This Astro propaganda is intended to distract from the fact that 3D at MDACC is much more than imrt at genesis.

 

[TheWallnerus]

Astro would like you to think that toxic health care economics is about utilization not the extortionistic prices at the board members own instituitions. The rest of the world is almost entirely imrt even for Mets. This Astro propaganda is intended to distract from the fact that 3D at MDACC is much more than imrt at genesis.

ASTRO’s striving to tie external beam reimbursement to APCs, and approval for that in the 2026 rule, is validating evidence to this assertion.

 

[fiji128]

Astro would like you to think that toxic health care economics is about over utilization not the extortionistic prices at the board members own instituitions. The rest of the world is almost entirely imrt even for Mets. This Astro propaganda is intended to distract from the fact that 3D at MDACC is much more than imrt at genesis.

Astro going to astro. Has been that way for at least a generation. It would be nice if they were just more upfront about it for those that are not completely aware at this point. The organization is completely captured by very high cost and pay no taxes "academic" centers so that's who interests are promoted.