Reforms Can Pave the Way for the Future of Cancer Care

“You have cancer.” Just decades ago, these three words were almost always equivalent to a death sentence. But recent medical innovations have transformed the cancer diagnosis from a death sentence to a carefully designed plan of action. Survival rates for almost all types of cancers are steadily on the rise. Medical innovations, years in the making, are now revolutionizing cancer treatment and making these three dreaded words easier to hear. Today cancer patients have more hope than ever before.

As a practicing radiation oncologist and Chief Medical Officer of 21st Century Oncology, I am on the front lines of this war on cancer. My patients are the beneficiaries of these advancements in cancer care. I have witnessed first hand how medical innovations are saving lives. From my view, we are finally making progress, delivering hope where there once was only fear.  Yet I am increasingly concerned about threats made by some policymakers in Washington, DC to systematically strangle funds dedicated to improving and investing in cancer care. With these additional Medicare cuts now on the table, I am extremely concerned for my patients and my profession. It is time that physicians, patients and future patients take a stand.

Conveniently (for policy makers pushing these cuts), the complexity of the government’s proposal to reduce Medicare reimbursement for cancer care makes it a daunting task to evaluate where and what the proposed cuts are and what they mean. Nobody has yet sounded alarm bells because the general public and policymakers do not understand just what these reductions mean.  I have taken the time, along with other colleagues in my profession, to study these proposals. What we have discovered is that these proposed changes translate to deep cuts to cancer therapies that will have a negative impact on our care delivery, patients and the cancer care profession as a whole.

In my role at 21st Century Oncology, I oversee a broad network of radiation oncology centers, serving more than 35,000 patients in 17 states.  Like so many across the country, our freestanding facilities provide a community-based alternative care setting to hospital outpatient departments, offering a convenient and preferable option for many patients.

The integrated, community-based radiation oncology model has become a fundamental part of our nation’s cancer care delivery infrastructure.  Nearly 65 percent of all cancer patients will require radiation during their treatment and more than 40 percent of those patients will seek care in freestanding facilities. These numbers are increasing with what we are learning in our medical research. Tailoring cancer care to the individual patient means that access to state-of-the-art treatments is now a life-saving proposition.

In spite of this, the Centers for Medicare & Medicaid Services (CMS) has consistently reduced payments to freestanding radiation oncology centers over the past decade. In fact, community-based treatment centers receive approximately 20 percent less in Medicare reimbursements than they did in 2005.  Still though, CMS has recently proposed an additional six percent in cuts to freestanding radiation oncology in its latest physician fee schedule (PFS) proposed rule for 2016.

At first glance, it may seem that federal decisions are unilaterally enforced to reduce spending.  However, this is simply not the case. Instead, the government has largely maintained reimbursement levels for hospitals, which perform the exact same service at 125 percent of the price of freestanding centers, a fact that is unfair to the patient, the payer and ultimately the taxpayer.

While budgetary atrophy can be perilous in any industry, it’s particularly dangerous when dealing with the health and wellbeing of vulnerable cancer patients. If budget-cutting measures crafted by CMS for freestanding oncology centers take effect, the availability of radiation oncology in the community-based setting could be greatly limited for our patient population.

Recognizing the mounting challenges on the horizon for freestanding cancer care, oncologists like myself – and other leaders throughout the cancer care community – have been developing innovative policy solutions that are good for the patient and good for our nation’s cancer care delivery system.

Consider our work at 21st Century Oncology.  In an attempt to support value-based care, we collaborated with oncologists to create a “bundled” payment model for radiation oncology.  Under the “bundled” payment system, payers reimburse for the full course of care, rather than specific procedures.

From a clinical standpoint, “bundled” payments allow doctors to freely pursue clinically advanced, personalized treatment paths for their patients.  Importantly, this approach also ensures that patients receive only necessary services as well as those that have been proven to work best against their cancer.  From a financial standpoint, the system is just as beneficial. While fee-for-service systems generally incent increased utilization, bundled payment models encourage efficiencies. Any economist will tell you that aligning incentives is fundamental in bolstering efficiency.  The payment system we’ve created does just that, and our Medicare policymakers should take notice.

Our own patient-centric, physician-developed reforms work. These reforms, coupled with the entrepreneurial physicians who are working to develop even more advanced patient-centric reforms will continue our upward trajectory of improved treatments and outcomes.  Despite their immense potential to elevate care and cut costs, ideas simply need funding to survive.  Conversely, decade-long divestment pulls the plug.

Policymakers should reverse course when it comes to radiation oncology.  Instead of enacting cuts put forth in the 2016 PFS proposed rule, they should support freestanding radiation centers, the skilled clinicians they employ and the vulnerable patients they serve. Moreover, CMS should work with the industry’s brightest minds to install innovative payment reform, which can leave a lasting impact.  Radiation oncology has simply become too important to too many people to threaten its wellbeing.

“You’ve got cancer.” It is no longer a death sentence. Americans diagnosed with cancer today are far better off than their predecessors. However, this fact is not a forgone conclusion for generations of cancer patients to come.  Let’s continue on a path toward saving as many patients as we possibly can, and that begins with fully supporting radiation oncology reforms that benefit the patient, protect innovations and preserve the integrity of cancer care delivery in the US by not cutting cancer care.


Constantine A. Mantz, MD is the Chief Medical Officer of 21st Century Oncology, the largest global, physician led provider of integrated cancer care services. The company offers a comprehensive range of cancer treatment services, focused on delivering academic quality, cost-effective patient care in personal and convenient settings.

Morning Consult