May 17, 2022 — Radiation oncologists will meet with congressional leaders and staff today to ask for their support of policies to bolster access and equity in cancer care. Today’s American Society for Radiation Oncology (ASTRO) Advocacy Day is the first to be held in-person since the start of the COVID-19 pandemic.
Radiation oncologists and medical physicists from across the country will participate in more than 100 meetings, where they will urge lawmakers to:
- Preserve access to care through stable Medicare payments and a fair radiation oncology alternative payment model
- Prevent prior authorization delays and disruptions for people needing urgent cancer treatments
- Increase federal investments in radiation oncology research and advance health equity measures to eliminate cancer disparities
More than one million people receive radiation therapy each year to treat cancer and other diseases. Radiation oncologists are calling on Congress to continue its longstanding support of patients and the larger cancer care community, with an emphasis on three legislative priorities:
ASTRO Ask #1: Support stable, value-based Medicare payments for radiation oncology that will improve access and quality, advance equity and reduce costs
Radiation oncologists provide thousands of cancer cures to people each year and offer patients significant value through cost-effective care. Despite these contributions, radiation oncology has faced more Medicare physician payment cuts than any other medical specialty, including cuts for radiation therapy in community-based clinics that total 20% over the last 10 years.
Millions of dollars in additional cuts are forthcoming due to clinical labor price updates scheduled for the next four years. Clinics faced with such significant cuts often have no choice but to reduce vital staff and services, cancel technology investments and, in some cases, close or consolidate – limiting patient access to cancer treatments.
While ASTRO agrees that updates to clinical labor pricing are needed, such steep reimbursement cuts – up to 10% for several key cancer treatments – are untenable. Radiation oncologists therefore are asking members of Congress to support legislation this year to mitigate existing and forthcoming cuts to radiation oncology and other specialties under the new clinical labor price update. Radiation oncologists also are calling for major reforms to Medicare’s physician payment system to stop the annual cycle of cuts and ensure stability, access, value and equity.
“Medicare is not meeting its obligation to maintain fair and stable payments,” said Laura Dawson, MD, FASTRO, Chair of the ASTRO Board of Directors. “These excessive reductions jeopardize access to life-saving radiation therapy services for Medicare beneficiaries at a time when clinics are recovering from the COVID-19 pandemic and treating patients with more advanced cancers.”
In April 2022, the Centers for Medicare and Medicaid Services (CMS) announced an indefinite delay to the radiation oncology alternative payment model (RO Model). The model’s excessive payment cuts and administrative burden have drawn significant criticism from the radiation oncology community and bipartisan members of Congress. ASTRO remains committed to value-based payment for radiation oncology, however, and is developing a new proposal for an alternative payment model to share with stakeholders later this year. The new proposal will emphasize ways to help patients from economically and socially marginalized groups access and complete radiation treatments.
“We continue to believe that episodic payments for radiation therapy services have great potential to improve access and quality, advance health equity and reduce cancer care costs, and we will continue to advocate for proposals that achieve these goals,” said Dr. Dawson.
ASTRO Ask #2: Restrict excessive prior authorization practices that delay patient care and waste health care resources
Prior authorization is consistently ranked by radiation oncologists as the biggest challenge facing their clinics, and radiation oncology faces the most prior authorization hurdles of any medical specialty, causing unnecessary anxiety, delays and harm for people already dealing with the burden of cancer.
Nine in 10 radiation oncology practice leaders say their patients are delayed from cancer treatment due to prior authorization, and a majority say the average delay lasts a week or longer. Research has linked each week of delay in starting cancer therapy with a 1.2% to 3.2% increased risk of cancer death. Seven in 10 radiation oncologists say their patients regularly express concerns about their treatment delays due to prior authorization.
While radiation oncologists face a disproportionately high number of prior authorization obstacles, these problems stretch across the American health care system. An April 2022 report from the inspector general’s office of the Health and Human Services Department concluded that 13% of Medicare Advantage prior authorization requests, or about 85,000 beneficiaries, were improperly denied in 2019.
“Obstructive prior authorization practices create potentially life-threatening delays to cancer treatment,” said Dr. Dawson. “Despite well-intentioned goals to manage health care utilization and control costs, this broken process ultimately harms patients and wastes health care resources. ”
The Council for Affordable Quality Healthcare estimated that $686 million in spending was associated with conducting prior authorizations in 2021. A separate study calculated a $40 million annual financial impact for the time required to secure approvals at academic radiation oncology clinics.
ASTRO is one of more than 450 organizations asking lawmakers to pass the Improving Seniors' Timely Access to Care Act of 2021 (H.R. 3173; S. 3018), which currently has 292 bipartisan co-sponsors in the House and 24 bipartisan co-sponsors in the Senate, to bring much-needed transparency and oversight to the prior authorization process and help curb delays for people receiving cancer treatment.
ASTRO Ask #3: Support increased research funding for radiation oncology to enable continued innovation and state-of-the-art care
Bipartisan support for cancer research has contributed to averting 3.2 million deaths from cancer in the U.S. in the past three decades. The COVID-19 pandemic, however, threatened this progress: millions of cancer screenings were delayed, 80% of non-COVID clinical trials were stopped or interrupted and valuable resources were diverted from cancer research. Radiation oncologists, therefore, are asking lawmakers to renew and increase support for the National Institutes of Health (NIH) and the National Cancer Institute (NCI), in contrast to the 3% decrease in NCI funding proposed in the president’s FY2023 budget.
Earlier this month, ASTRO asked NIH Director Douglas Lowy, MD, for increased funding specifically for radiation oncology research. Radiation therapy is partially or fully responsible for 40% of all cancer cures, yet NIH forecasts indicate that radiation oncology research accounts for less than 6% of the FY2022 NCI budget.
“Investment in radiation oncology research creates outsized benefits for the public, with the potential to improve cure rates and provide palliative relief for millions of people,” said Dr. Dawson. “Federal funding also supports cutting-edge technologies – such as radiopharmaceuticals, precision medicine and powerful new combinations of cancer therapies – that increase survival and improve our patients’ quality of life.”
In addition to asking for increased research funding, radiation oncologists will focus on several related initiatives: ASTRO strongly supports the DIVERSE Clinical Trials Act (H.R. 5030/S. 2706) to improve representation of individuals from minority populations in clinical research by removing barriers to participation. Radiation oncologists also are urging lawmakers to ensure that the recently reignited Cancer Moonshot initiative supports efforts to enhance radiation therapy access, address disparities in care and treatment outcomes and reduce obstacles to care. Finally, radiation oncologists are asking for adequate funding for the Advanced Research Projects Agency for Health (ARPA-H) that does not pull funding from other NIH programs.
For more information: www.astro.org
July 31, 2024 
