Oversaturation of proton centers in US

[radiaterMike]

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for IMRT, IGRT technical is bundled. For non IMRT the professional and technical components are billed (typical case would be CBCT when using non-IMRT 3D for Stage III NSCLC)

 

[seper]

This was daily CBCT on non-IMRT case. MD probably got his RVU's, but therapist's work, physicist and machine time was being given for free, and the hospital was not OK with that.

Was the issue insurance fraud or simply the fact it was a service they wouldn't get paid for? Also, I thought there is only professional reimbursement for IGRT in a hospital setting?

 

[Reaganite]

for IMRT, IGRT technical is bundled. For non IMRT the professional and technical components are billed (typical case would be CBCT when using non-IMRT 3D for Stage III NSCLC)

What you're saying definitely applies to freestanding centers. I was told in past there is no technical component reimbursement for IGRT in the hospital setting...whether IMRT or 3D. Maybe I'm wrong?

 

[medgator]

for IMRT, IGRT technical is bundled. For non IMRT the professional and technical components are billed (typical case would be CBCT when using non-IMRT 3D for Stage III NSCLC)

I think the imrt/igrt bundling was a recent change (last year??) Freestanding otherwise has been able to bill technical on igrt while hospital-based has not.

Ditto for verification simulation films, which are not billable on imrt but are in 3D

 

[scarbrtj]

I've seen one of my colleagues (employed RadOnc) trying to do daily image guidance when it was denied by insurance, without billing for it. The issue was quickly escalated through the hospital command chain and the physician was forbidden to do so in the future.

Should go in the "Don't Choose Rad Onc As a Specialty" thread. Freakin' idiotic. Can no one remember in the early days of IMRT sans IGRT when people were doing daily port films and we knew daily port films would be denied ALWAYS by EVERYONE? In fact early "expert consensus" practice guidance in IMRT was to do a daily (or at least more than weekly) MV port film.

 

[medgator]

Never knew this but not surprised:

Wise Buy? Proton Beam Therapy

It helps only a few, and at a wildly extravagant cost

www.medpagetoday.com

At the 2016 annual meeting of the American Society for Radiation Oncology (ASTRO), researchers reported that the use of proton therapy was growing, but barely. In 2012, 5,377 patients were treated. That rose to just over 7,000 in 2015. The number of cases of prostate cancer, the most commonly treated condition, was nearly unchanged at about 2,300 cases annually. (The figures are from survey data collected by the National Association for Proton Therapy.)

During the period in question here, 2012 to 2015, the number of proton treatment centers doubled. That means the number of prostate cancer patients seen per center is dropping -- not a good thing when trying to cover a $220-million investment.

Before moving to Virginia, Palta was at the University of Florida. "We had a proton facility at Jacksonville and a main campus in Gainesville. Our radiation oncologists in Gainesville would not send patients to Jacksonville. They would make the excuse that 'there's no evidence that protons are better. So why put the patients through a 70-mile drive [to Jacksonville]?'" This was not a question of competing institutions fighting for healthcare dollars. It was a civil war: both the Gainesville and Jacksonville facilities are part of the University of Florida.

 

[Mandelin Rain]

"They would make the excuse that 'there's no evidence that protons are better. So why put the patients through a 70-mile drive [to Jacksonville]?'"